Silent cerebrovascular disease and vascular dementia of the Binswanger type in patients with headache, dizziness or vertigo

Abstract

Although non-specific complaints (e.g., mild to moderate headache and dizziness) are considered to relate to silent cerebrovascular disease (CVD), the prevalence of abnormal findings on computed tomographic (CT) scans in patients with such symptoms has not been reported. The purpose of our study was to assess prospectively the characteristics of CT images in patients with headache, dizziness or vertigo. From August 1993 to May 1994, we examined 70 consecutive outpatients with headache, dizziness or vertigo who were 40 years of age or older (27 men and 43 women; age range, 40 to 87 years; mean age 67 ± 12 years) at Kaita Hospital. The patient's own description of their headache, dizziness or vertigo was first elicited in an open-ended fashion, and then a structured interview was conducted to characterize specific aspects of the complaints, according to a standardized protocol before undertaking radiological assessments. A CT scan of the brain was performed, basically, on the day of referral.
Among 62 CT scans in the 70 patients, brain infarction was demonstrated in 19 cases (18 with small infarction and one with moderate-sized borderzone infarction). A history of CVD was present in 6 cases, so that the prevalence of silent CVD was 21% (13/62). White matter lesions were found in 4 cases, and of these, 3 showed extensive lesions, and were diagnosed as vascular dementia of the Binswanger type. The prevalence of hypertension was 67% in lesion-positive patients with a history of CVD and 77% in those with silent CVD, respectively, and these values were significantly higher than the 37% in patients without infarction on CT (p <0.05, X² test).
Patients with silent CVD were significantly older than those without infarction (p < 0.008, ANOVA and an unpaired t-test).
In summary, we found CT evidence of silent stroke in 21% of cases who visited our outpatient clinic because of headache, dizziness or vertigo. Age and hypertension appear to be major factors for such silent infarction in patients with headache, dizziness or vertigo.