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MRI done. Diagnosed with microvascular ishemic disease of brain. Is this a dementia?

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Internal Medicine Specialist
Practicing since : 2001
Answered : 2272 Questions
GP had MRI done due to dizziness, falling and balance and cooridation for about 5 day, Hospitalized and diagnosed with Microvascular Ishemic Disease of Brain - Severe. I have high cholesterol, Diabetis and controlled high blood pressure i am on Medicine for all three. Now doing inhome physical therapy - 3 times a week and balance and dizziness is much better. Therapist has been hinting toward inner ear problem. He has done exercise of tilting my head to loosen calcium crystals in inner ear. to see if this would help dizziness. It did help somewhat I am on a walker which GP said I would be on for life. I had a hemmorratic stroke 10 yrs ago and have had several small, mild strokes. I am 70 years old. Dizziness is gone now, cooridation/balance is about 90% better, if I move slow. Do I still need to use walker while outside or would I be alright using no walking aids. As I worry what would happen if symptoms came back. Do you think they will come back or was that a once in a life time event? People are telling me this disease is known to cause dementia, I have not noticed any signs of forgettfullness to date., but have noticed while do my finances, I need to double check and sometimes forget how to complete them, what would I be seeing if I was to develop Dementia. Could I be diagnosed wrong and just had a XXXXXXX stroke instead? Any help would be appreciated. Thank you/
Posted Thu, 2 Aug 2012 in Brain and Spine
Answered by Dr. Ram Choudhary 3 hours later

Welcome to healthcare magic!
Microvascular strokes associated with hypertension are called Binswanger's disease and are a well known cause for dementia in long run as the stroke accumulate over time. The memory disturbances, the balance and rigidity of the postures, tremors all are associated in these cases but to varying extent.
You are one of the luckiest who is having intact memory and minimum dizziness despite all this and that ripe age, I think the regularity with your medicine is paying it's due.
Please continue with the walker till you are very sure that you do not have dizziness and you can do without it and not because you do not like the orthosis help. Reason being these patients are very vulnerable to falls and one fall may be the last fall if it results in vertebral fracture or a neck femur fracture with subsequent complications.
Your diagnosis seems pretty right and when demented you do not make your diagnosis- others do! So I do not think that is the problem right now.
Dizziness in your case is bound to return, take regular medications, take care to avoid extreme temperature variation.
Get a review with your Neurologist to know if you have a BPPV- That calcium granule displacement problem told to you by physiotherapist.
The list of medicines you have mentioned is indispensable for you, please stick to a regular medication habit so that you can maintain your health at optimum level and limit the complications.
I hope this advise would be helpful for you.

Still if you have any queries or doubts, please write me back,
I would be happy to solve them.

Wish you a great health!
Above answer was peer-reviewed by
Follow-up: MRI done. Diagnosed with microvascular ishemic disease of brain. Is this a dementia? 51 minutes later
First, thank you for the direct and informative answer. I do have some questions. From what I have told you do you think my disease is at a severe stage and the longer I have had this disease (which my physician has said I have had it for a long time) will it show its complete effects fairly soon? I am losing weight as I am over weight and on Diabetic diet, diligent with my medicine and therapy and I am beginning to feel a bit like myself old self. Should I be more careful or if I feel good do things like taking out my own garbage which I have several steps and no railing to hold onto, going downstairs to do laundry? I do not drive so I would have friends, family for transportation. Do I need to watch for signs of XXXXXXX strokes as my physician seems to think I will do fine from now on out and gathered from his conversation with me and my daughter that I should not worry about stroke. I live alone and do have stairs, do I always need to avoid these stairs whenever possible? My daughter says sometimes I am what she calls a "little off base" not sure what she is trying to tell me. thank you again, I appreciate your advise more than you will ever know.
Answered by Dr. Ram Choudhary 56 minutes later

Welcome back to healthcare magic Physicians!

The Binswanger's disease that is micro vascular disease of brain related to hypertension is a chronic disease by definition.
Hypertension has to be long standing to produce it.
These finding do not come overnight, Your GP is absolutely right.
I do not think your disease is in severe stage, you have tamed it well with your regular medication habit so carry on.
It is a long disease may be at current pace it will take some 10-20 yrs to ripe.
At your age dieting must be very slow and should not bring drastic fall in weight, I would say avoid it if not necessary, if at all then reduce the weight over a period of at least a year not in weeks like the freaks do. That is harmful.
I would strongly advise against stair- A stair can prove snake and ladder game like dip in status in your case. Please shift to ground floor(I live with my mother, Just two month back shifted to ground to avoid stair for her knee problem.), make sure you have a walk every day.
You are on very good medicines and should not worry about strokes.

I think the advise would be helpful for you.

If you still have queries if any, please feel free to communicate back.

And if satisfied with my solution then please accept the answer and take a moment to post your view in the Review Section about my Clinical skills!

Wish you a great XXXXXXX

Above answer was peer-reviewed by
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