White matter matters in chronic vestibular syndrome: Implications for prevention

The pathophysiological connection between white matter hyperintensities (WMH), a manifestation of small vessel disease (SVD) and chronic vestibular syndrome (CVS) is poorly understood. In this retrospective study, we analyzed the diagnoses, cardiovascular risk factors and co-morbidities of patients seen at the specialized vertigo center with a focus on CVS. We screened 381 patients seen in 2022 at the Neurologic Vertigo Center, University Hospital Inselspital Bern. Patients have been categorized into two groups, according to their vestibular signs and symptoms: A first group consisting of patients with a CVS (n = 177), which includes the symptom of dizziness, and a comparison group with patients affected by an episodic vestibular syndrome (EVS, n = 204). Seventy-five cases of the total study population showed WMH classified according to Fazekas scale 1-3 in brain MRI. We performed chi-square tests followed by a Bonferroni correction to investigate the associations between cardiovascular risk factors, WMH and CVS vs. EVS, respectively. 48.2 % with CVS presented with WMH of Fazekas 1-3. Patients with CVS were statistically significant more likely to have arterial hypertension (p < 0.001) and hyperlipidemia (p < 0.001). Diabetes mellitus, obesity, nicotine abuse, daily alcohol consumption or a family history of cardiovascular diseases were more frequently observed in the CVS group. We analyzed the association between WMH and polyneuropathy (PNP) in the total population, which was statistically significant (p < 0.001). Our results show the importance to consider cardiovascular risk factors and thereby causative pathologies like SVD or PNP that have an impact on the vestibular system, in prevention, diagnosis, and therapy of chronic vestibular disorders.