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Diagnosed with microvascular ischemic disease of brain. On medicine for high cholesterol, diabetics. Any suggestion?

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Practicing since : 2001
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GP had MRI ran do 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 has done exercise of tilting my head to loosen inner ear. I am on a walker which GP said I would be on for life. Have headache each day, worsens as day goes on. Could my microvascular ishemic disease diagnos be wrong and all it is is inner ear infection? Maybe I am just kidding myself. I had a hemmorratic stroke 10 yrs ago and have had several small, mild strokes. I am 70 years odl. Recent office visit with my physician who diagnosed me with Microvascular ischemic brain disease acted like I was perfectly fine, inquired about how much therapy and was told could stop whenever I felt strong and same with using walker stop using when I felt strong. Why when in hospital, physician would explain to myself and my daughter that this was serious and caused both of us some anxiety, now acts like I am perfectly fine and nothing wrong. What should I believe, go on once balance and cooridation seem better with same life or should I invest this diagnose further
Posted Mon, 23 Jul 2012 in Brain and Spine
Follow-up: Diagnosed with microvascular ischemic disease of brain. On medicine for high cholesterol, diabetics. Any suggestion? 46 minutes later
I failed to mention my physician does not want to see me for 4 months . My question is do you think what I have is not serious and will clear up in 4 months or is this the usual way this disease is handled. I feel like my doctor either thinks it is not as severe as he had stated in the hospital or there is nothing he can really do for me, so this is how he wants to handle it. My family is upset with his attitude and I want to have an answer to give them Thank you
Answered by Dr. Shiva Kumar R 33 minutes later
Hello and thank you for sending your question.

Your question is a good one and I will work on providing you with some information and recommendations regarding the symptoms you are experiencing.

From the information given to me I personally feel you are suffering from Benign paroxysmal positional vertigo (BPPV) and not related to ischemia of the brain. However headache is not the feature of BPPV and one has to rule out the possibility of high BP causing dizziness and imbalance. Other cause of headache is tension type headache which commonly presents with daily headache which usually start in the afternoon and increase towards evening.

BPPV develops when a small piece of bone-like calcium breaks free and floats within the tube of the inner ear. This sends the brain confusing messages about your body's position. To diagnose benign positional vertigo, perform a simple bed side test called the Dix-Hallpike maneuver. If positive, most effective treatment is a bedside procedure called "Epley's maneuver XXXXXXX which can move the small piece of bone-like calcium that is floating inside your inner ear.

My recommendation for you is to see your Vertigo specialist or a Neurologist for a good physical examination and consultation. You need to be on antiplatelets, cholesterol lowering agents along with anti-hypertensives to reduce the risk of multiple lacunar infarcts in the future. BPPV is common and can be cured in 80% of the cases with Epley's maneuver and labrynthine exercises.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate.

If you have any additional concerns regarding your question I would be happy to address them.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
Above answer was peer-reviewed by
Follow-up: Diagnosed with microvascular ischemic disease of brain. On medicine for high cholesterol, diabetics. Any suggestion? 7 hours later
Thank you for your answer I will follow up on the BPPV idea and see if I can receive the manuvear done on my head. Without you seeing my MRI results but being told by my physician giving me diagnose severe Microvascular Ischemic Disease does it perhaps sound like I do not have this disease at all. Also, if I did have this disease which I am beginning to think I don't what would be my symptoms and threats. I have been frightened since I was told this as my physician told me not to fall as a bad fall could cause my death. Also, it would progress and there is no help for it other than controlling my diabetis, cholesterol and blood pressure which for the last 6 weeks I have been very doing. What are some of the signs of microvascular ishemic disease in the brain? I am beginning to feel like a nut case and just would like to get on living like I did but my family since hearing my physician give me the diagnose have been watching every thing I do. I know it is hard, like I said without seeing my MRI but what should I believe as my physician really does not seem to want to talk about it. thank you and I promise I will not continue to bug you but just want a basically clear answer and then I can go from there. Bless You
Answered by Dr. Shiva Kumar R 16 hours later

Thanks for the follow up query

Microvascular ischemic disease is a common finding in people above the age of 40 years and is even more common in people suffering from hypertension, high cholesterol, obese and people suffering from diabetes. So I am not surprised by the findings on the MRI in you. You can reduce the progression by controlling these vascular risk factors. Microvascular ischemic disease is only a MRI finding and most do not have any clinical manifestations except little bit of memory problems.

So I feel you should not be disturbed by the MRI findings and aim for good control of risk factors to reduce the future risk of progression of the disease.

Wishing you good health.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
Above answer was peer-reviewed by
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