Are white matter abnormalities associated with “unexplained dizziness”?
Open accessAbstract
INTRODUCTION: Although cerebral small vessel disease is a significant contributor to the development of imbalance and falls in the elderly, whether it causes dizziness is not known. METHODS: A retrospective case analysis was conducted for 122 dizzy patients referred to two neuro-otology tertiary centres in London and Pisa. Patients were divided into 'explained' causes of dizziness (e.g. benign positional vertigo, vestibular neuritis, orthostatic hypotension, cerebellar ataxias) and 'unexplained' dizziness. White matter hyperintensities (WMH) in MRI (T2 weighted and FLAIR sequences) were blindly rated according to the Fazekas scale. RESULTS: 122 patients; 58 (mean age=72, SD=7.95 years) in the 'unexplained' group and 64 (mean age=72.01, SD=8.28 years) in the 'explained' group were recruited. The overall frequency of lesions (Fazekas 1-3) significantly differed between groups (p=0.011). The frequency of severe lesions (Fazekas 3) was significantly higher in the 'unexplained' group (22%) than in the 'explained' group (5%; p=0.003). CONCLUSION: Increased severity of WMH in cases of unexplained dizziness suggests that such abnormalities are likely contributory to the development of dizziness. WM lesions may induce dizziness either because patients perceive a degree of objective unsteadiness or by a disconnection syndrome involving vestibular or locomotor areas of the brain.
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Neurodegenerative disorders that affect posture and gait such as Parkinson's disease, cerebellar degeneration, including the downbeat nystagmus syndrome, and small vessel white matter disease may manifest with dizziness or unsteadiness when standing or walking before motor signs can be detected on physical examination.
“Neurodegenerative disorders that affect posture and gait such as Parkinson’s disease, cerebellar degeneration [61], including the downbeat nystagmus syndrome [89], and small vessel white matter disease [2, 16, 66] may manifest with dizziness or unsteadiness when standing or walking before motor signs can be detected on physical examination.”
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- Authors
- Ahmad, H., Cerchiai, N., Mancuso, M., Casani, A. P., & Bronstein, A. M.
- Affiliations
- Charing Cross Hospital (GB)
- Azienda Ospedaliera Universitaria Pisana (IT)
- University of Pisa (IT)
- Corresponding author
- Ahmad, Hena
- Cerchiai, Niccolò
- Mancuso, Michelangelo
- Casani, Augusto P.
- Bronstein, Adolfo M.
- Venue
- Journal of the Neurological Sciences
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 358
- Issue
- 1-2
- Pages
- 428-431
- ISSN
- 0022-510X (ISSN-L)
- PMC
- PMC4640145
- OpenAlex
- W2148530440
- Cited by
- 66
- References
- 20
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 5 · 2023: 7 · 2022: 5 · 2021: 11 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 7 · 2016: 1
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of the Neurological Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- Imperial College London
- Università di Pisa
- Medical Research Council (MR/J004685/1)
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- white matter hyperintensities, cerebral small vessel disease, Fazekas scale, otoneurology, vestibular dysfunction, disconnection syndrome, elderly patients
- MeSH terms
- Aged, Aged, 80 and over, Dizziness, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Leukoencephalopathies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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