Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoen- cephalopathy (CADASIL) is a genetic disease that is usually considered a disorder of young or middle age adults. However, the disorder has important expression vari- ability, with mild cases presenting in old age increasingly reported in recent years. In these cases, clinical and radiological fndings can be attributed to other diseases like small-vessel disease, and the typical neuroimaging fndings may be the only clue for a correct diagnosis. Here we present the case of a 79 year-old man with several vascular risk factors and recurrent strokes, in whom the diagnosis of CADASIL was not considered until his daughter received it.