Patient KL is a 45-year-old premenopausal female with a history of CADASIL (diagnosed by NOTCH3 mutation analysis) manifested by frequent transient ischemic attacks and chronic headaches who presented to the emergency department with unstable angina and new T wave inversions in the precordial leads, consistent with Wellens' T waves (Figure 1). This evidence concerns the gene NOTCH3 and CADASIL.