Despite of its name, CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a systemic vascular disease related to mutations in the NOTCH 3 gene located on chromosome 19. The clinical course of CADASIL is highly variable, even within families and carriers of the same mutation. The onset of the disease is usually in 4-5 decade of life. CADASIL manifests clinically as migraine with aura, recurrent ischaemic strokes, mood disorders, and progressing dementia. Early presence of abnormalities in autoregulation of the cerebral blood flow is characteristic for the disorder. On T2-weighted MRI scans diffused hyperintensities in the cerebral white matter are visible. Involvement of the anterior temporal lobe and external capsule on brain MRI is considered as radiological feature for the disease. The pathologic hallmarks of CADASIL are degeneration and loss of vascular smooth muscle cells in resistant middle- and small-sized arteries, and presence of granular osmiophilic material (GOM) in wall of small vessels. Diagnostic criteria which allow to diagnose the disorder involve positive result of genetic examination and the presence of GOM deposits in vessel wall in skin or muscle biopsy. Since pathomechanism of CADASIL is unknown, treatment of the disease is only symptomatic. This review focuses on an update of CADASIL clinical picture, diagnosis and management based on the recent basic and clinical evidences.