A22 year-old man from South India presented with migraine with aura and depression. Neurologically, he demonstrated cognitive impairment, pseudobulbar affect and bilateral pyramidal signs. The magnetic resonance imaging (MRI) scan of his brain [Figure 1] showed increased FLAIR and T2 signals in the bilateral anterior temporal and frontal white matter, basal ganglia and external capsule. The clinical features and the MRI finding of bilateral white matter lesions in the anterior temporal pole and external capsule, in the absence of hypertension and optic nerve and spinal cord lesions, were diagnostic of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).1-