Other differentials encompass genetically related leuko-vasculopathy, such as cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL)41– MIM ∗613,111 –, cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)—MIM 600142, due to variants in HTRA1, which has been also identified in CADASIL aggregates and presents with characteristic features such as alopecia, spondylosis, and severe leuko-vasculopathy with extensive involvement of the posterior fossa.42 Here, CTSA is linked to CARASIL.