The Overlooked Diagnosis: A Case Report on Autonomic Dysfunction and Chronic Dizziness in an Elderly Patient With Neuroimaging Correlation.

Dizziness is a common yet diagnostically challenging complaint in the elderly, often resulting from multifactorial causes such as vestibular dysfunction, autonomic impairment, and cerebrovascular disease. This case report describes a 74-year-old woman with persistent, non-vertiginous dizziness, exacerbated by postural changes, but without orthostatic hypotension or classic vestibular signs. Comprehensive evaluation, including autonomic function tests, tilt-table testing, and neuroimaging, revealed autonomic dysfunction and chronic small-vessel ischemic changes in the periventricular white matter, along with a small hypodense lesion in the pons. Specifically, the patient exhibited reduced heart rate variability, impaired parasympathetic reflexes, and cerebrovascular alterations suggestive of disrupted autonomic pathways. This case underscores the importance of integrating autonomic testing with neuroimaging to elucidate the underlying pathophysiology of chronic dizziness in elderly patients.