Aging with Cerebral Small Vessel Disease and Dizziness: The Importance of Undiagnosed Peripheral Vestibular Disorders

Abstract

Recent studies showed a link between cerebral small vessel white matter disease (SVD) and dizziness: patients whose dizziness cannot be explained by vestibular disease show severe SVD and gait abnormalities; however, little is still known about how SVD can cause this symptom. The primary aim of this study is to examine the possible underlying causes of dizziness in neurovascular patients; this is in order to assess whether treatable causes could be routinely disregarded. A secondary aim is to possibly define a central oculomotor pattern induced per se by SVD. This could help the diagnosis of SVD-related dizziness. In this single-blind prospective study, 60 patients referred to a neurovascular clinic because of dizziness and SVD on imaging were divided into an L-SVD and a H-SVD group (low and high SVD burden, respectively), and then blindly examined with vestibulometric tests. In H-SVD group, the percentage of unexplained dizziness reached 82.8%. There was a higher prevalence of peripheral vestibular abnormalities in the L-SVD patient group (51.6%) than in the H-SVD (17.2%; p = 0.012). We found no differences in central oculomotor findings between the two groups. Although oculomotricity does not show any consistent pattern, a severe SVD can directly represent a cause of dizziness. However, a patient with mild SVD is more likely to suffer by a peripheral vestibular disorder. Therefore, given the high incidence of vestibular disease in neurovascular or geriatric clinics, clinicians should be cautious when ascribing dizziness solely to the presence of SVD as easily treatable peripheral vestibular causes may be missed.

Consciously processing balance leads to distorted perceptions of instability in older adults

“…Despite the present cohort reporting an absence of any recent (within the past 6 weeks) bouts of dizziness, our findings highlight that anxiety-provoking situations that lead to enhanced conscious balance processing can induce distorted perceptions of instability in an older adult population. While dizziness is common in older adults [1], in at least 50% of cases, symptoms cannot be explained through traditional neurological or neurootological testing (and are, thus, 'unexplained') [6][7][8]. The present findings provide strong evidence for the role of attentional factors in the development of acute dizziness symptoms in this population.…”

“…Chronic dizziness is often attributable to specific neurological, cardiovascular or vestibular dysfunction. However, in at least 50% of cases in older adults, dizziness cannot be explained through traditional neurological or neuro-otological testing [6][7][8]. This does not necessarily mean that neurological or neuro-otological dysfunction is absent, but rather that symptoms of dizziness cannot be readily attributed to such dysfunction using currently available clinical tests.…”

Vestibular Test Results of a Patient with Cerebral Microangiopathy and Idiopathic Thrombocytopenia

“…Other commonly co-occurring clinical symptoms included dementia, stroke symptoms, transient ischemic attack symptoms, incontinence, vertigo, and seizures. 2 Further evidence of this need to diagnose CM as early as possible was shown in a study done by Cerchiai et al, 11 in which they researched possible underlying causes of dizziness in neurovascular patients. This study identifies CM as "small vessel disease" (SVD).…”

Oxidative Stress in Cerebral Small Vessel Disease Dizziness Patients, Basally and After Polyphenol Compound Supplementation

“…The clinical and biochemical improvement after the polyphenol supplementation supports the hypothesis that oxidative stress plays a role in cSVD. Despite no pathophysiological cause has been identified for dizziness in patients with cSVD, it is likely that a reduced white matter perfusion could interfere with subcortical networks involved in gait [ 11 , 12 ]. Oxidative stress is associated with NO production, which is known to have a protective role in endothelium and to empower blood flow, especially in small vessel circulation [ 44 ].…”

“…Moreover, vertigo and dizziness are common neurological signs (about 30% in elderly) that frequently remain “unexplained” [ 11 ] . In a recent study, we have demonstrated that more than 80% of unexplained dizziness was associated with a higher cSVD burden [ 12 ].…”