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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small artery disease of mid-adulthood caused by mutations of the NOCTH3 gene on chromosome 19. Ischemic manifestations are the most frequent clinical events in CADASIL: 60-85% of patients have had transient ischemic attacks (TIAs) or complete strokes. Magnetic resonance imaging (MRI) shows on T2-weighted images widespread areas of increased signal in the white matter associated with focal hyperintensities in the basal ganglia, thalamus, and brainstem. Diagnostic testing with immunostaining using anti-NOCTH3 antibodies is an alternative method that seems easier than electronmicroscopy and particularly useful before initiating a complete screening of the gene in difficult cases. As CADASIL is a vascular disorder responsible for cerebral ischemic events, different authors prescribe aspirin for secondary prevention, but its benefit in the disease has not been shown. Treatment of migraine should be restricted to analgesic agents and nonsteroidal anti-inflammatory drugs.
Very long term survival after diagnosis of malignant glioma has been described in individual case reports. Survival of more than 10 years is extremely rare, especially when identified in 3 out of 71 patients assigned to one arm of a randomized controlled trial.
Three patients survived 11, 16, and 18 years following the diagnosis of glioblastoma and treatment with surgery, conventional fractionated radiation, and high-activity iodine-125 boost brachytherapy as part of a randomized controlled trial.
Despite this apparent cause and effect relationship, statistical analysis shows no relationship between these cures and treatment with brachytherapy. Cure of glioblastoma remains rare.
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