Chronic Lacunar Infarcts and Dizziness

Diagnosis

The American Heart Association suggests that true vertigo is more likely related to peripheral vestibular causes, while non-specific dizziness is more consistent with chronic small vessel disease and lacunar infarcts 1, 2
Characterizing the dizziness precisely, including duration, triggers, and associated symptoms, is crucial for diagnosis 1, 3
A targeted physical examination, including the Dix-Hallpike maneuver and orthostatic vital signs, can help rule out other causes of dizziness 1, 3

The American College of Cardiology recommends aggressive vascular risk factor modification, including blood pressure control, antiplatelet therapy, and statin therapy, as the primary treatment focus 4
Vestibular rehabilitation therapy can significantly improve gait stability and balance in elderly patients with chronic dizziness 1
Fall risk assessment and home safety modifications are critical, as dizziness increases fall risk 12-fold in elderly patients 1, 3

MRI brain without contrast is the appropriate imaging modality for evaluating chronic lacunar infarcts as a cause of dizziness 1
CT head has extremely low diagnostic yield (<1%) for isolated dizziness and should not be used 1
White matter hyperintensities and silent lacunar infarcts on MRI are associated with increased risk of cognitive decline 5

Patients with lacunar infarcts face increased risk of cognitive decline and vascular dementia, particularly affecting executive function 4
Recurrent stroke rates are similar to other stroke subtypes, and death from cardiovascular causes is a significant risk in the mid- to long-term 4