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Background.: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small vessel disease caused by mutations in NOTCH3 with remarkable phenotypic heterogeneity.CADASIL cases caused by homozygous NOTCH3 mutations are rare and subsequently understudied.In this study we investigate mutational and clinical features within homozygous patients with CADASIL.