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Abstract

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare hereditary small-vessel disease caused by NOTCH3 mutations, leading to recurrent ischemic strokes, cognitive decline, and early-onset dementia. Oxidative stress has been implicated in the pathophysiology of small-vessel cerebrovascular disease, but therapeutic strategies targeting oxidative injury remain limited. We present a 40-year-old female with recurrent ischemic strokes involving the right and left middle cerebral arteries, persistent hypercoagulability of unknown etiology, and no identifiable inherited or acquired thrombophilia. Despite well-controlled blood pressure and standard medical management, the patient remains at high risk for cerebrovascular injury. An extensive review of antioxidant therapies—including glutathione, vitamins C and E, Coenzyme Q10, alpha-lipoic acid, N-acetylcysteine, melatonin, and omega-3 fatty acids—is presented, summarizing preclinical and clinical evidence for neurovascular protection and mitigation of oxidative stress. These interventions may offer adjunctive benefits for patients with CADASIL or CADASIL-like presentations. Further clinical studies are warranted to evaluate the efficacy, safety, and long-term outcomes of targeted antioxidant therapy in this population.

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