Expert: Mary Gordon - 1/5/2007

Question
i have been having dizziness and loss of balance for some time.  no headaches, hypertension, etc.  do have type II diabetes that is controlled with oral medication.  also, had tongue cancer approx 2 years ago...with left side of my tongue being removed...never smoked or drank.  my family doctor sent me for an mri to rule out " trans cereb ischemia"...rec'd my results today & not really sure if there is anything to worry about...my doctor just said there were no signs of a mass or cancer...however, the reports states: " ventricals are normal in size. no shift of midline indicators.  no bleed is identified. there is mild increase in t2 weighted signal in the periventricular deep white matter bilaterally". impression reads:  "findings suggestive of mild bilateral periventricular deep white matter small vessel ischemic disease.  no bleed or space occupying lesion is identified".
i understand there is no lesion, but i do not understand the rest.  is this something i should be concerned about?  should i see a neurologist?  i would appreciate any input you might have.  thank you!  

Answer
If I were you, yes, absolutely I would ask to see a neurologist.

Small vessel disease implies blockages of small vessels in the head, and is often associated with hypertension or diabetes. It can also be associated with autoimmune diseases that can cause inflammation.  It is usually managed with medications such as plain aspirin and ticlid, along with optimizing treatments for hypertension and diabetes. Small vessel disease is a major cause of cognitive impairment and dementia - what gets called multi-infarct or vascular dementia, because it leads to small strokes and blockages - so small that a person may not have stroke symptoms - just an accumulation of brain damage over time from an endless series of small blockages.  

I'd be asking for a referral to an expert who can explain your specific results to you, and work with you to head this off at the pass so to speak. You need all your marbles! You'd hate to beat the cancer and live on but lose your ability to enjoy those extra years.

You also have had dizziness and loss of balance, so I'd say a neurologist is your next stop.

M.