Brain Imaging in Patients with Vertigo

Key Indications for Brain Imaging

The American College of Radiology recommends brain imaging for patients with acute persistent vertigo when neurological examination reveals focal deficits, with a reported incidence of up to 11% of patients having acute brain infarcts, particularly posterior circulation stroke 1, 3
Brain imaging is indicated in patients with acute vestibular syndrome when HINTS examination suggests a central cause, including normal head impulse test, direction-changing nystagmus, or skew deviation 4

The American College of Radiology suggests MRI as the preferred modality for evaluating vertigo due to superior soft tissue resolution, with the ability to better characterize masses, inflammatory processes, demyelinating disease, and small infarcts 1, 2
MRI with diffusion-weighted imaging (DWI) is recommended for detecting central causes of vertigo, with a higher sensitivity compared to CT 1
CT may be used as an initial rapid screening tool when MRI is not immediately available, with a reported detection rate of 6% for acute brain lesions in patients with central positional paroxysmal vertigo (CPPV) 1, 5