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October 2020 -
Volume 18, Issue 10

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From the Editor

Editorial
A. Abyad (Chief Editor)
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Original Contribution

General Population Awareness Regarding Colorectal Cancer and its Determinants in Aseer region, Saudi Arabia
[Abstract]
[pdf]
Shehata Farag Shehata, Mohammed Saeed Alqahtani, Nawaf Ahmad Yahya, Abdullah Ali Aseeri, Mohammed Ali Alotaif, Abdulaziz Ali Abdullah
DOI: 10.5742MEWFM.2020.93868

Knowledge, attitudes and practices of school teachers regarding acute complications of type 1 diabetes mellitus in Abha city, southwestern Saudi Arabia
[Abstract]
[pdf]
Razan S. Al Humayed
DOI: 10.5742MEWFM.2020.93869

Knowledge, Attitude and Practices of Type 2 Diabetic patients attending a tertiary care hospital in Karachi
[Abstract]
[pdf]
Kanza Baig, Tafazzul Hyder Zaidi, Kiran Mehtab, Marium Farid, Shajeeya Khaliq, Wajiha Mukhtar, Shiza Tariq, Fozia Zaidi
DOI: 10.5742MEWFM.2020.93870

Prevalence and predictors of depression among medical students in Jeddah, Saudi Arabia
[Abstract]
[pdf]
Yousria Badawy, Areej Alsaggaf, Amani Bardi, Omnia Alganmi , Turki Alshehri
DOI: 10.5742MEWFM.2020.93871

Population and Community studies

Assessment of knowledge and practice of mothers regarding breastfeeding and contraception in the postpartum period in primary care centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia
[Abstract]
[pdf]
Aida AlDughaither, Hadeel AlMutairi
DOI: 10.5742MEWFM.2020.93873

Family History of Cancer, Trend of Genetic Counselling and Screening in Karachi: A Survey among Students of Jinnah Sindh Medical University
[Abstract]
[pdf]
Nazish Jaffar, Syeda Ghadeer Zehra Naqvi, Rohma Momna, Maria Raza, Aliza Babar, Aliya Jafri
DOI: 10.5742MEWFM.2020.93874

Prevalence of primary headache among King Khalid University students in 2019
[Abstract]
[pdf]
Shehata Farag Shehata, Adnan Q. Al-Malki, Abdulrahman J. Alqahtani, Anas Ali Abo Tamraa, Ahmed Hussain Almutlaq, Ali Saad Alshamrani, Abdulelah Eed Alotaibi, Khalid Mohammed Alotaibi, Khalid Hussein Almutairi, Sultan Ali Alqahtani
DOI: 10.5742MEWFM.2020.93875

Perceptions of parents regarding polio vaccination in Karachi
[Abstract]
[pdf]
Hareem Arshad, Tafazzul Hyder Zaidi, Kiran Mehtab, Jibraeel Khan Durrani, Amna Anam, Ruqqiya Wahid, Aiman Nisar, Aroosa Hussain, Alia Mehboob, Shujaat Husain, Nadia Rubab Zaidi, Fozia Zaidi
DOI: 10.5742MEWFM.2020.93876

Awareness and Pattern of Utilizing Family Planning Methods in Married Women of Duwakot, Nepal
[Abstract]
[pdf]
Raut Binod, Kharel Sushil
DOI: 10.5742MEWFM.2020.93877

'A positive thing by mentioning it':
a qualitative study of experiences of brief physical health interventions for individuals diagnosed with severe mental illness in primary care
[Abstract]
[pdf]
Hassan Awan, Mohsin Allah Ditta, Mick McKeown, Karen Whittaker
DOI: 10.5742MEWFM.2020.93878

Difficulties facing family physicians in primary health care centers in Abha City, Saudi Arabia
[Abstract]
[pdf]
Hatim Mohammed Ali Alsharafi, Bassam Mousa Khalawy Mokali
DOI: 10.5742MEWFM.2020.93879

Remote consultations; what you need to know
[Abstract]
[pdf]
Rubena Ali Malik, Philip Sadler
DOI: 10.5742MEWFM.2020.93880

Bridging The Gap: A review of communication skills challenges for expatriate doctors in the Arabian Gulf
[Abstract]
[pdf]
Asif Parvez Malik, Ameer Muhammad Khan
DOI: 10.5742MEWFM.2020.9381

Review

Recognising depression in elderly patients in general practice
[Abstract]
[pdf]
Mohammed Ansary
DOI: 10.5742MEWFM.2020.93882

Case Report

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) in a young adult with migraine
[Abstract]
[pdf]
Mohammed Ansary
DOI: 10.5742MEWFM.2020.93883


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE
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Editorial Office -
Abyad Medical Center & Middle East Longevity Institute
Azmi Street, Abdo Center,
PO BOX 618
Tripoli, Lebanon
Phone: (961) 6-443684
Fax:     (961) 6-443685
Email: aabyad@cyberia.net.lb
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Publisher -
Lesley Pocock
medi+WORLD International
AUSTRALIA
Email: lesleypocock@mediworld.com.au
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Editorial Enquiries -
abyad@cyberia.net.lb
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Advertising Enquiries -
lesleypocock@mediworld.com.au
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While all efforts have been made to ensure the accuracy of the information in this journal, opinions expressed are those of the authors and do not necessarily reflect the views of The Publishers, Editor or the Editorial Board. The publishers, Editor and Editorial Board cannot be held responsible for errors or any consequences arising from the use of information contained in this journal; or the views and opinions expressed. Publication of any advertisements does not constitute any endorsement by the Publishers and Editors of the product advertised.

The contents of this journal are copyright. Apart from any fair dealing for purposes of private study, research, criticism or review, as permitted under the Australian Copyright Act, no part of this program may be reproduced without the permission of the publisher.
October 2020 - Volume 18, Issue 10

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) in a young adult with migraine

Mohammed Ansary

Correspondence:Dr Mohammed Ansary
MBBS, FRACGP, Post Grad Cert in Psychiatry
Member of National Rural Faculty, NSW Australia,
Member of Bangladesh Medical and Dental Council, Bangladesh
General Practitioner
Galston Medical Centre
31 Arcadia Road, Galston
NSW 2155
Phone: 02 96532133
Fax: 02 96531385
Email: dr.mansary@yahoo.com

Received: August 2020; Accepted:September 2020; Published: October 1, 2020. Citation: Mohammed Ansary. CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) in a young adult with migraine. World Family Medicine. 2020; 18(10): 120-121 DOI: 10.5742/MEWFM.2020.9388

Case Presentation

A 44-year-old female presented to our practice with the complaints of sudden onset of severe headache and migraine associated with visual aura, dizziness and fogginess in her head. This was her first episode of the kind and she could only see through half of her vision. She was having daily headaches and migraine in the lead up to this episode.

Past medical history included depression, migraine and rosacea. She was medicated with citalopram 20 mg daily for treatment of depression and was on minocycline 50 mg twice daily for rosacea.

On physical examination she had malar rash, her visual acuity was normal with no evidence of papilloedema or vascular changes. Extra ocular movements were normal. The rest of the cranial nerves’ examination were normal. Upper and lower limb examinations were normal. A gait examination did not reveal any abnormality. Cognitive assessment was unremarkable.

As part of the initial assessment and due to suspicion of a possible intracranial pathology a CT brain scan was performed, showing patchy low-density regions throughout the white matter and a recommendation was made for an MRI scan for a detailed assessment. The patient was referred to a neurologist and subsequent investigation with MRI revealed extensive bilateral periventricular and deep white matter hyper intensity throughout the cerebral hemispheres as well as anteromedial aspects of the anterior temporal poles bilaterally, favouring CADASIL. Differentials considered were, Systemic Lupus Erythematous (SLE), CADASIL and Fabry disease. Further investigations included serum autoantibodies, inflammatory markers, spinal fluid analysis and thrombophilia screen which returned normal results. For confirmation of diagnosis of CADASIL patient was referred for skin biopsy by a dermatologist. A confirmed diagnosis of CADASIL was made by presence of osmophilic granular deposits in the arterioles. Investigation for Fabry disease was deferred.

Corroborative history was taken from family members. Patient’s mother suffered from migraine and was under care of a neurologist. Patient’s father had long standing history of epilepsy, since the age 18. No other relevant history of note. Both parents were alive, both were in their late sixties and none were diagnosed with CADASIL.

The patient declined genetic testing and following skin biopsy, declined genetic counselling initially due to fear of implications it held for her three young children. After further discussions with empathetic approach, the family decided to have genetic counselling.

 







 


 
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