This study investigated the relationship between the cross-sectional area (CSA) of the cervical vagus nerve (VN) and cerebral white matter lesions (WMLs) in patients with vascular risk factors. Using carotid ultrasonography, the CSA of the VN was measured in 196 patients with a history of stroke and comorbidities. The study found that the CSA of the right VN was significantly larger than that of the left VN. Decreased CSA of both the right and left VN was associated with greater severity of WMLs. The study suggests that autonomic nervous system dysfunction, reflected by VN size, may play a role in WML progression, although causation was not established. The study included patients who had undergone MRI and excluded those with Parkinson’s disease or inflammatory neuropathy.