Imaging of dizziness

The imaging of the dizzy patient: computed tomography versus magnetic resonance imaging

“…Computed tomography MD Meniere's disease MRI Magnetic resonance imaging Dizziness is one of the most common presenting symptoms in both primary and tertiary settings, accounting for up to 10 % of primary-care presentations [1,2] and approximately 4 % of the presentations at the emergency department [2]. Depending on its aetiology, it is usually classified as peripheral/vestibular or central; this classification is important not only for diagnostic purposes but also and mainly for targeted treatment.…”

“…Despite the repeatedly shown lower predictive yield on emergency settings than MRI [2,8,9], CT can still be of great help. Indeed, CT can demonstrate posterior fossa haemorrhage and large infarcts [2].…”

“…Despite the repeatedly shown lower predictive yield on emergency settings than MRI [2,8,9], CT can still be of great help. Indeed, CT can demonstrate posterior fossa haemorrhage and large infarcts [2]. Additionally, given the diagnostic advantages of CT in assessing osseous structures, CT is still the scan of choice in cases of skull base fracture, a suspected 'third window' effect, such as superior semi-circular canal dehiscence or even chronic otitis media with or without cholesteatoma and erosion of the labyrinth, assessing the operated ear (displaced middle ear/stapes prosthesis) and looking for inner ear malformations [2,10].…”

“…Additionally, diffusion-weighted imaging demonstrates 83 % sensitivity for acute ischaemic stroke [9] while non-echo planar diffusion is highly sensitive and specific in detecting primary, residual or recurrent cholesteatoma [10]. MRI has been shown superior to CT by many studies in assessing the selected dizzy patients on acute settings [2,8,9]; such repeatable findings cannot be ignored.…”

Diagnostic yield and impact of MRI for acute ischaemic stroke in patients presenting with dizziness and vertigo

“…8 Patients with AIS are at greater risk for further ischaemic events and require appropriate preventive measures to be instated prior to discharge. 9 Secondary complications of cerebellar or brainstem infarction, including swelling and haemorrhagic transformation, can be fatal and require close monitoring and early neurosurgical intervention in the event of clinical deterioration. 10 In view of the difficulties in reliable clinical distinction between peripheral and central causes of dizziness and vertigo, frontline clinicians often refer the patient for imaging to exclude acute ischaemic stroke, especially in patients who have a previous history of stroke or have responded poorly to medical treatment for benign vestibular disorders.…”