Leukoaraiosis and Dizziness: Are They Related? – A Case Series

Dizziness and imbalance are one of the most common complaints seen in elderly people. Age-related ischemic diseases have varying degrees of manifestations and imbalance problems. Cerebral small vessel white matter disease has recently been a topic of interest in view of its association with geriatric syndromes–development of cognitive decline, dementia, falls, etc., but the association between small vessel disease and dizziness has not established clearly yet. Magnetic resonance imaging (MRI) brain is the most commonly used imaging modality for neurological disorders. White matter hyperintensities (WMHs) on T2-weighted sequences on MRI are known as leukoaraiosis (LA) and are suggestive of small vessel white matter disease and represent a high risk of cerebral, cerebellar, and brainstem stroke. The purpose of the present study is to investigate the correlation between unexplained vertigo and radiological changes of LA (small vessel disease) and videonystagmography (VNG) findings of such patients. First patient, a 55-year-old male patient had complaints of short-lasting episodes of spinning sensation and imbalance for the past 2 years. MRI brain showed small vessel ischemic changes (leukoaraiosis) with right vascular loop type 3 (anterior inferior cerebellar artery) without compressive symptoms. VNG showed broken smooth pursuit in horizontal and vertical planes; a hypometric saccades tracing in both planes and microsaccadic oscillations in spontaneous gaze. Second patient, a 60-year-old male had recurrent episodes of vertigo for the past 15 years. His VNG showed micro-oscillations in the saccades and impaired smooth pursuit. MRI revealed bilateral symmetrical T2 FLAIR hyperintensities in white matter and lateral ventricles. Third patient, a 69-year-old female presented with giddiness, nausea, and vomiting for 5 days. Pure-tone audiogram showed mild sensorineural hearing loss. MRI brain showed diffuse cerebral atrophy with small vessel ischemic changes. VNG showed impaired smooth pursuit and microsaccadic oscillations when the gaze was fixed. All three patients were managed successfully by vestibular rehabilitation and antioxidants and Coenzyme Q10. Through this study, we would like to highlight the possibility of a relation between leukoaraiosis and unexplained dizziness among elderly patients.