Small vessel ischemic disease in the brain does NOT typically cause vertigo as you describe. Actually, most people don't have any symptoms unless it is wide spread or significant in size/amount of the ischemia (which yours did not indicate). The only other symptoms typically reported with SVID is cognitive type problems with thinking, memory, etc...which you haven't said you experience. Again, this would only be normally seen with significant SVID, not mild.

So hopefully this will ease your mind about the significance of this finding. I can say that the SVID may be from the Sjogren's...I have pretty significant SVID as a result of my Sjogren's...but I also have APS and have had 3 strokes and numerous TIA's.

It will be very interesting to see if there is any changes in your MRI from 18 months ago and now...that is what will tell whether your changes (vertigo) are consistent with any disease process that has progressed. If I remember correctly, you didn't have the vertigo back when the first MRI was done.

You really need another biopsy. I thought you had positive findings for SFN on the first. If it was negative, then by all means it should be repeated. And most importantly, is to have the morphology done on the next skin biopsy. One significant finding with Sjogren's related SFN is that the fiber density can be normal but the morphology (condition of the fibers) show damage. My density was normal on the first biopsy, but the damage was very clear with segmented, torturous, and swollen fibers in many areas. This is what Sjogren's can do to the fibers...not necessarily only reducing density. And this finding is just, if not more, important. You also need to have more than one location done on each leg. There is NO way to determine length or non-length dependent SFN if only one site is biopsied on the each leg.

Hope this helps. Please keep us posted.