Background: Older people develop gait and balance dysfunction that is associated with gradual onset of cerebral white matter disease. The term cerebral small vessel disease refers to a group of pathological processes with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. White matter disease is easily detected by neuroimaging, whereas small vessels are not, hence the term small vessel disease is frequently used to describe the parenchyma lesions rather than the underlying small vessel alterations.
Aim of the work: To investigate the relationship between presence and/or absence of white matter disease identified on magnetic resonance imaging with the vestibular findings in elderly patients with dizziness.
Patients and Method: Study population: 30 elderly patients complaining of dizziness & / or instability. Inclusion criteria: Patients above 55 years old with history of vertigo & / or instability. Exclusion criteria: 1- Meniere's disease. 2- Bilateral vestibulopathy. 3- Recent vestibular neuritis or labyrinthitis. 4- History of head trauma or surgery. 5- Neurological diseases as (Intracranial space occupying lesions, Multiple Sclerosis, Parkinsonism, Paresis). 6- Patients with otologic history of otorrhea or Ear surgery. Study Procedure: 1- Full history taking. 2- Otological examination. 3- Hearing assessment. 4- Immittancemetry. 5- Video-nystagmography test (VNG). 6- Magnetic resonance imaging (MRI) & Magnetic resonance angiography (MRA) “Stroke protocol".
Results: Abnormal VNG test results were significantly higher in patients with atherosclerotic changes (0.04). The most common VNG finding was positional nystagmus.
Conclusion: Presence of risk factors for white matter disease (WMD) in elderly patients as hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia and migraine is an indication for requesting further radiological assessment. The most frequent VNG abnormality in elderly patients with WMD is positional & positioning nystagmus. Presence of atherosclerotic changes is significantly related to presence of VNG test abnormality.