Health problems that blighted the Roman general Julius Caesar may have resulted from a spate of mini-strokes, according to a fresh review of his symptoms.

The great military leader, who was instrumental in the rise of the Roman empire, suffered a host of medical ailments, from vertigo, dizziness and insensibility to limb weakness that on occasion caused him to fall over.

In one of the most prominent incidents, Caesar collapsed at the battle of Thapsus in 46BC and had to be carried to safety. In his biography of Caesar, the Greek historian Plutarch suggested the fall was an epileptic attack.

The diagnosis has prevailed for centuries since, though scholars have not been short of other proposals, including bad migraines and seizures brought on by malaria or a parasitic brain infection caught during his Egyptian campaign.

But doctors at Imperial College, London, argue in new research that the symptoms described in Greek and Roman writings point to a different diagnosis entirely. They believe that rather than suffering from late onset epilepsy, Julius Caesar had a number of mini-strokes that damaged him physically and triggered changes in his mental state too.

“All of the symptoms reported in Caesar’s life are compatible with him having multiple mini-strokes,” said Francesco Galassi, a medical doctor at Imperial who conducted the analysis with Hutan Ashrafian, a surgeon at the college.

Born in 100BC, Caesar rose swiftly through the political system, conquered Gaul, and crossed the Rubicon river under arms, sparking the civil war that ultimately left him dictator of Rome. But his rule was cut short when he was assassinated in the Senate on March 15, 44BC.

Until now, the possibility that Caesar suffered from cardiovascular disease, or was prone to strokes, has been largely ruled out because he was apparently otherwise well in private and state affairs.

But Galassi and Ashrafian claim that a series of mini-strokes could explain incidents recorded by scholars that epilepsy cannot. Towards the end of his life, Caesar suffered from depression and his personality changed, potentially through damage to his brain caused by strokes.

A mini-stroke may also have led to Caesar’s apparently emotional response to a speech by Cicero in his later years. Caesar’s complexion changed, he began to shake, and he dropped a handful of documents on hearing the great orator. Another attack might account for his failure to stand up as senators honoured him, an act that was interpreted as defiant.

“The idea that he was epileptic is unfounded,” Galassi told the Guardian. “We think others start from the assumption that he had epilepsy. Our theory is simpler and more logical,” he said.

The doctors see support for their theory in the works of Pliny the Elder, who noted that both Caesar’s father and another forefather died without apparent cause while putting on their shoes. The deaths could have resulted from epilepsy, but Galassi and Ashrafian argue in the journal Neurological Sciences that a stroke or heart attack seem more likely.

“Even if Caesar participated in an active lifestyle and may have benefited from a Mediterranean diet, there is the added possibility of genetic predisposition towards cardiovascular disease,” the doctors write.

At the time of Caesar’s reign, epilepsy was considered a “sacred disease”, and it may have suited him, and his chosen heir, Octavian, to maintain that he suffered from the disorder. The doctors argue that for a man of Caesar’s prominence, there are simply too few detailed accounts of his attacks for the diagnosis to be credible.

Christopher Pelling, professor of Greek at Oxford University, said that Caesar’s disease has long been thought of as epilepsy. “I’ve no idea if it’s medically plausible, but it’s interesting, and it would matter,” he said. “Any physical ailment wouldn’t have helped, whether it was epilepsy of something else.”