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Cerebral Autosomal Dominant Arteriolopathy with Subcortical Infarcts and Leucoencephalopathy (CADASIL) is a recently but increasingly recognized cause of migraine with aura, early and recurrent strokes, and dementia, with an autosomal pattern of transmission. The disease is a widespread vasculopathy, but it is clinically expressed in the CNS only. Cerebral MRI is always abnormal in symptomatic patients, and sometimes in asymptomatic but affected individuals. It shows more or less confluent hypersignals on T2-weighted and flair images. A spectrum of mutations in the Notch3 gene on chromosome 19 are responsible for the disease. There is no specific treatment and the prognosis is poor. We followed three patients from 2 families with genetically confirmed CADASIL and we present their clinical characteristics. We discuss current data on this rare, but non exceptional arteriolopathy.

Melatonin is a hormone mainly secreted by the pineal gland during the dark phase of the light-dark cycle. The most known function of melatonin in mammals is to transmit information concerning light-dark cycles playing the role of an active neuroendocrine transducer of environmental information. Given this chronobiologic role of pineal melatonin, it seems to be useful in the management of shift work, jet lag and some sleep disorders. In vitro like in vivo melatonin seems to be effective as an antioxidant and oncostatic agent. Melatonin may provide protection against aging process, degenerative diseases, cancer and play a role also in sexual maturation, reproduction, immune function and psychiatric illness. The administration of melatonin in the jet-lag syndrome is well codified. Further clinical research is needed for a better understanding and definition of other indications, treatment regimens and safety of the hormone. The aim of this paper is to review the current knowledge on its clinical implications.

Melatonin is a hormone mainly secreted by the pineal gland during the dark phase of the light-dark cycle. The best known function of melatonin in mammals is to transmit information concerning light-dark cycles playing the role of an active neuroendocrine transducer of environmental information. Although melatonin circadian rhythm is endogenous, based on 25 hour cycles, it is modulated by light-dark cycle. During the day, the light signal is sent to the pineal gland through a special neuronal pathway and inhibits melatonin secretion. During the night, the last neuron of this pathway which is coming from the cervical ganglion superior releases nonadrenalin in the interstitium. Nonadrenalin stimulates melatonin synthesis through cAMP accumulation. Some factors other than light can also influence melatonin levels. Electromagnetic fields, age, male sex, Cushing syndrome, hypogonadotrophic hypogonadism, alcoholism seem to be associated with lower melatonin secretion. Female sex, hypergonadotrophic hypogonadism, sport and fasting seem to be linked to higher melatonin secretion. Some pathologies and drugs can modulate some steps of the neuroanatomic pathway of melatonin synthesis. Stress has no effect. The influence of weight and height is still investigated. Once released, melatonin can act on different organs through specific receptors (retina, supra-chiasmatic nucleus, hypophysis, brain, blood vessels, digestive tract, ovaries).