Abstract
Case A 58-year-old woman presented with peripheral vertigo on a background of dyslipidaemia, hypertension, Grave’s disease, depression, anxiety, and no family history of stroke.
Examination revealed right sensorineural deafness and a positive Unterberger test suggesting vestibular aetiology. The remaining neurological exam was normal with no cognitive impairment.
Her MRI brain demonstrated incidental findings of extensive T2 FLAIR white matter hyperintensities that were not proportional to her age and were consistent with CSVD. Infective, inflammatory, autoimmune and demyelinating aetiologies were ruled out by blood and CSF testing. Her folate, B12 and Holter monitor investigations were unremarkable. Genetic testing for NOTCH -3, TREX-1, HTRA-1, COL4A2 and MTHFR variants are pending. She was counselled for modifiable stroke risk reduction and commenced on aspirin.
Discussion CSVD frequently remains undetected until its symptoms manifest in advanced stages posing substantial health risks and complications worldwide.1 As the burden of disease increases so does the risk of future stroke. Early detection and proactive management are essential for reducing the risk and burden of future stroke.1 2
Conclusion Further studies are needed to formulate guidelines to quantify the burden of CSVD and formulate management plan especially in asymptomatic CSVD cases.
References
Das AS, Regenhardt RW, Vernooij MW, Blacker D, Charidimou A, Viswanathan A. Asymptomatic cerebral small vessel disease: insights from population-based studies. Journal of Stroke. 2019 May;21(2):121.
Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. The Lancet Neurology. 2010 Jul 1;9(7):689–701.
