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Thursday, April 27, 2017
Small vessel disease
I am a 62 year old woman who was previously diagnosed with cerebellar ataxia about 8 years ago. My symptoms have worsened over the past 8 years. After 2 MRIs and evoked potential testing my neurologist states I have small vessel disease and not cerebellar ataxia as my former neurologist had stated. I am having a great deal of trouble walking and now use a cane and/or rollator. I also have double vision when fatigued. I can find no information on "small vessel disease". Will this continue to worsen? I have even had to retire from my job. He has put me on aggrenox. Thank you.
I have written several previous answers about "small vessel disease" which is also called "white matter disease", "periventricular white matter disease", "small vessel ischemic changes", etc. I would refer you to these answers to get more information. As these previous answers state in detail, these terms refer to changes seen on imaging studies such as MRI scans, and these changes are not associated with any neurologic symptoms for many patients.
When two neurologists have differing opinions, it may be prudent to get a third opinion. I do not know the details of your history and cannot examine you, but can tell you that double vision when fatigued is not a typical symptom of either cerebellar ataxias or "small vessel disease". Other disease processes might need to be considered.
Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati