Treatment & management
There is no cure for CADASIL and no treatment proven to stop it. Care focuses on preventing strokes — controlling blood pressure, not smoking, managing vascular risk factors — plus treating migraines and depression. Some common stroke drugs (strong blood thinners and clot-busters) carry extra bleeding risk in CADASIL and are used with caution.
No cure yet — but that doesn't mean nothing helps. The strongest evidence is almost boringly practical: keep blood pressure controlled, don't smoke, manage the ordinary vascular risks, stay active, and treat depression when it shows up. Migraines can be treated normally (triptans are safe here, despite old fears). Two cautions matter: strong blood thinners and the clot-busting drug tPA can raise bleeding risk in CADASIL, so they're used carefully and case-by-case. Make sure any ER treating you knows you have CADASIL.
- Recommended: control hypertension, diabetes, and cholesterol; smoking cessation; standard migraine management (triptans not contraindicated). Antiplatelets (e.g., aspirin) may be considered though unproven specifically in CADASIL.
- Used with caution: anticoagulants are generally avoided (high microbleed burden → higher hemorrhage risk) unless there's a clear separate indication; IV thrombolysis (tPA) is not routinely recommended by major guidelines, though a small 2024 case series reported mostly good outcomes without bleeding — an area of active debate.
Common questions
- Is there a cure for CADASIL?
- Not yet. Management focuses on stroke prevention and symptom control.
- What's the most important thing I can do?
- Control blood pressure and don't smoke — the highest-yield, best-evidenced levers.
- Can CADASIL patients take aspirin?
- Sometimes considered for prevention; discuss with your neurologist. Strong blood thinners are used more cautiously.
- Is tPA safe in CADASIL?
- Guidelines are cautious due to bleeding risk; it's decided case-by-case. Tell any ER you have CADASIL.