Ischemic brain lesions in aged patients with dizziness.

OBJECTIVE: To compare neuro-otological test results in aged patients complaining of dizziness with their magnetic resonance imaging findings.

DESIGN: The presence of lacunar infarcts of the hind-brain was used as a gold standard.

SETTING: A department of otolaryngology in a regional general hospital.

PATIENTS: All patients over 60 years old with dizziness during a period of 1 year 2 months, excluding those with central lesions of other than vascular origin (n=48).

RESULT: Lacunar infarcts were found in 22 patients: the cerebellum for two patients, the brain stem for 17, and both regions for three. Patients with lesions of the cerebellum or the lower brain stem showed central vestibular abnormalities, whereas eight patients with only the upper brain-stem lacunae did not. A canal paresis was found in 12 of 20 patients with the brain-stem lacunae. Patients without lesions in the posterior fossa did not show significant abnormalities, indicating central disorders.

CONCLUSION: This study documents a high prevalence of lacunar infarcts of the hindbrain in patients over 60 years old with dizziness, and it also demonstrates the difficulty in detecting small lesions of only the upper brain stem by neuro-otological tests. This calls attention to a differential diagnosis in aged patients with dizziness.