Diagnostic Contribution of Magnetic Resonance Imaging and Computerized Tomography in Patients with Unidentified Vertigo and Normal Neurologic Examination in Emergency Medicine

Abstract

Background: Vertigo and dizziness are common symptoms in patients presenting to emergency medicine (ED) clinics. Vertigo may be  caused by peripheral or central origin. Routine imaging is not indicated; however, neuroimaging is increasing, and published studies  have revealed a small number of positive findings on imaging modalities.

Aims: The aim of this study was to investigate whether neurological imaging was necessary in patients classified as “unidentified vertigo,” who were admitted to the emergency department  with vertiginous complaints and not revealing typical peripheral vertigo findings and any neurological deficits.

Materials and Methods: All  patients with “dizzy symptoms” were included in the study. For patients who met the definition of “unidentified vertigo,”  experimental neurological imaging studies were done. Head computerized tomography (CT), magnetic resonance imaging (MRI) with  gradient-echo sequences (GRE), and diffusion weighted images (DWI) were used for imaging. Patients who underwent neuroimaging in  the ED were followed up for 6 months in Neurology and ENT clinics.

Results: A total of 351 patients were included in the study.  Experimental imaging was performed on 100 patients. CT detected a significant pathology associated with the vertigo complaint in only  one patient. MRI results were similar to the CT results. MRI-GRE sequences showed some additional pathologies in 14 patients and 4 of  them were thought to be related to vertiginous symptoms. None of the patients classified as “non‑central causes of vertigo” in the  neuroimaging group developed TIA or CVD during 6 months of follow-up.

Conclusion: Head CT can be adequate to exclude  life‑threatening central pathology in “undifferentiated vertigo patients” and the addition of MRI did not add any diagnostic accuracy in ED management. Using the physical examination findings effectively to make a specific diagnosis may reduce misdiagnosis and improve  resource utilization.