Anterior temporal lobe involvement in CADASIL

Brain MRI of a 46-year-old male with CADASIL and skin biopsy positive for granular osmiophilic material. There is hyperintensity in the periventricular and subcortical white matter on T2-weighted (A) and FLAIR (B) sequences, a nonspecific pattern that may be seen with other small vessel ischemic disease processes. In addition, there is increased signal intensity in the anterior temporal lobe white matter on T2-weighted (D) and FLAIR (E) sequences, a finding that may be more specific for CADASIL. Additional findings include a right periventricular lacunar infarction of CSF signal intensity (A, B, C) and involvement of the pons (D, E).