Stroke & CADASIL
In CADASIL, strokes happen because the NOTCH3 mutation damages the brain's small blood vessels, not because of clots from the heart or large arteries. They are the most common presenting sign, typically in mid-life. Prevention centers on controlling blood pressure and vascular risk factors; some standard stroke drugs need caution here.
The strokes in CADASIL are “small-vessel” strokes — the tiny arteries deep in the brain narrow and close off, rather than a clot traveling from elsewhere. That's why the prevention playbook and the cautions around strong blood thinners are specific to this disease. The two pages below cover both sides of it in full: how strokes fit the overall picture, and what actually reduces the risk.
Common questions
- Why do strokes happen in CADASIL?
- The NOTCH3 mutation damages the brain's small blood vessels, causing small deep (lacunar) strokes — not clots from the heart or large arteries.
- How are CADASIL strokes prevented?
- By controlling blood pressure and vascular risk factors and not smoking; strong blood thinners are used with caution. See the Treatment page.
Sources: NIH GeneReviews; NINDS; AHA Scientific Statement.
Evidence: Established
Last reviewed: July 2026.