Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy Presenting During the Postpartum Period as Postpartum Depression and Postpartum Psychosis

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare inherited disease that presents with neurologic manifestations such as stroke, psychiatric disturbances, migraine, and cognitive decline. We report a case of a previously well 27-year-old lady presenting with new onset confusion four weeks postpartum. On examination, there was right-sided weakness and tremors. A thorough history revealed existing diagnoses of CADASIL in 1(st) and 2(nd)-degree relatives. The diagnosis in this patient was confirmed by MRI of the brain and genetic testing for NOTCH 3 mutation. The patient was admitted to the stroke ward, treated with a single antiplatelet agent for stroke, and supported by speech and language therapy. There was a significant symptomatic improvement in her speech at the time of discharge. The mainstay of treatment for CADASIL remains symptomatic at this stage. This case report shows that the first presentation of CADASIL can mimic postpartum psychiatric disorders in a puerperal woman.