Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation

Jianjun Wang,1 Jinfang Li,2 Fanxin Kong,2 Hanqing Lv,3 Zhouke Guo2 1Department of Neurology and Psychology, the Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China; 2Department of Neurology and Psychology, Shenzhen Hospital of...

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Autores principales:	Wang J, Li J, Kong F, Lv H, Guo Z
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	CADASIL Bipolar II disorder Hypomania Notch3 White matter hyperintensities Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/32d20a6dfb034929affba271541ed248
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spelling	oai:doaj.org-article:32d20a6dfb034929affba271541ed2482021-12-02T00:16:44ZBipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation1178-2021https://doaj.org/article/32d20a6dfb034929affba271541ed2482017-08-01T00:00:00Zhttps://www.dovepress.com/bipolar-ii-disorder-as-the-initial-presentation-of-cadasil-an-underdia-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Jianjun Wang,1 Jinfang Li,2 Fanxin Kong,2 Hanqing Lv,3 Zhouke Guo2 1Department of Neurology and Psychology, the Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China; 2Department of Neurology and Psychology, Shenzhen Hospital of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China; 3Medical Imaging Department, Shenzhen Hospital of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China Abstract: Mood disturbances have been documented in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The highly varied morbidity indicates that the affective symptoms in CADASIL have not been cataloged systematically, leading to ineffective treatment, affecting the patients’ quality of life, and possibly resulting in suicide. We present a case of CADASIL with bipolar II disorder as the first manifestation. A middle-aged female reported recurrent depressive episodes and appeared treatment resistant to adequate dosages and durations of antidepressants. Following a structured psychiatric interview and neuropsychological assessment, a past episode of hypomania was identified. Added treatment with sodium valproate alleviated most symptoms. Considering late-onset bipolar disorder with unexplained decline in cognition, a medical history of migraine, and a suspected family history of stroke, further cranial magnetic resonance imaging scan was performed and revealed severe leukoencephalopathy, prompting further investigation. The diagnosis was revised to CADASIL after Arg587Cys NOTCH3 mutation was confirmed. This case highlights the evolving process of affective disorder diagnosis and underlying organic etiologies. Based on the overlap of white matter hyperintensities, NOTCH3 mutation, and valproate therapy in bipolar disorder and CADASIL, bipolar II depression may be a poorly recognized manifestation of CADASIL. Well-designed clinical trials are warranted to verify the current findings. Keywords: leukoencephalopathy, bipolar II disorder, hypomania, NOTCH3, white matter hyperintensitiesWang JLi JKong FLv HGuo ZDove Medical PressarticleCADASILBipolar II disorderHypomaniaNotch3White matter hyperintensitiesNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 13, Pp 2175-2179 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	CADASIL Bipolar II disorder Hypomania Notch3 White matter hyperintensities Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	CADASIL Bipolar II disorder Hypomania Notch3 White matter hyperintensities Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Wang J Li J Kong F Lv H Guo Z Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation
description	Jianjun Wang,1 Jinfang Li,2 Fanxin Kong,2 Hanqing Lv,3 Zhouke Guo2 1Department of Neurology and Psychology, the Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China; 2Department of Neurology and Psychology, Shenzhen Hospital of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China; 3Medical Imaging Department, Shenzhen Hospital of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China Abstract: Mood disturbances have been documented in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The highly varied morbidity indicates that the affective symptoms in CADASIL have not been cataloged systematically, leading to ineffective treatment, affecting the patients’ quality of life, and possibly resulting in suicide. We present a case of CADASIL with bipolar II disorder as the first manifestation. A middle-aged female reported recurrent depressive episodes and appeared treatment resistant to adequate dosages and durations of antidepressants. Following a structured psychiatric interview and neuropsychological assessment, a past episode of hypomania was identified. Added treatment with sodium valproate alleviated most symptoms. Considering late-onset bipolar disorder with unexplained decline in cognition, a medical history of migraine, and a suspected family history of stroke, further cranial magnetic resonance imaging scan was performed and revealed severe leukoencephalopathy, prompting further investigation. The diagnosis was revised to CADASIL after Arg587Cys NOTCH3 mutation was confirmed. This case highlights the evolving process of affective disorder diagnosis and underlying organic etiologies. Based on the overlap of white matter hyperintensities, NOTCH3 mutation, and valproate therapy in bipolar disorder and CADASIL, bipolar II depression may be a poorly recognized manifestation of CADASIL. Well-designed clinical trials are warranted to verify the current findings. Keywords: leukoencephalopathy, bipolar II disorder, hypomania, NOTCH3, white matter hyperintensities
format	article
author	Wang J Li J Kong F Lv H Guo Z
author_facet	Wang J Li J Kong F Lv H Guo Z
author_sort	Wang J
title	Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation
title_short	Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation
title_full	Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation
title_fullStr	Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation
title_full_unstemmed	Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation
title_sort	bipolar ii disorder as the initial presentation of cadasil: an underdiagnosed manifestation
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/32d20a6dfb034929affba271541ed248
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Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation

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