Treatment for Vertigo with Normal MRI Brain and MRA Head and Neck

Diagnostic Considerations

Vertigo with normal neuroimaging suggests peripheral vestibular disorders as the most likely cause, which can include Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis/labyrinthitis, Ménière's disease, and Mal de Debarquement Syndrome (MdDS) 1, 2, 3

The American College of Radiology recommends canalith repositioning procedures, such as the Epley maneuver, as the first-line treatment for BPPV, with 80% success rates after 1-3 treatments 2
For Vestibular Neuritis/Labyrinthitis, the American College of Radiology suggests follow-up treatment with vestibular rehabilitation exercises 1
The American Academy of Otolaryngology recommends dietary modifications, such as a low-salt diet, for patients with Ménière's disease 2

Benzodiazepines, such as diazepam, can be used for short-term management of severe vertigo and associated anxiety, as recommended by the American College of Radiology 2
Antiemetics, such as prochlorperazine, can be used for management of severe nausea/vomiting associated with vertigo, as recommended by the American College of Radiology 2

The American College of Radiology warns that vestibular suppressants have significant side effects, including drowsiness, cognitive deficits, and increased fall risk, especially in elderly patients 2
Prolonged use of vestibular suppressants can interfere with central compensation and delay recovery, as noted by the American College of Radiology 2

The American College of Radiology recommends VRT as the cornerstone treatment for most peripheral vestibular disorders with normal imaging findings, with benefits typically developing over weeks of consistent practice 5

The American Heart Association recommends dietary changes, such as limiting salt/sodium intake and avoiding high-sugar beverages, to help manage vertigo symptoms 2
Regular exercise and adequate sleep are also recommended to help manage vertigo symptoms, as suggested by the American College of Radiology 2

The American College of Radiology recommends reassessing patients within 1 month after initial treatment to document resolution or persistence of symptoms 2
Transitioning from medication to vestibular rehabilitation when appropriate can promote long-term recovery, as recommended by the American College of Radiology 2

The American College of Radiology warns against using vestibular suppressants long-term, which can interfere with central compensation and delay recovery 5, 2
Misdiagnosing one vestibular disorder as another can lead to inappropriate treatment approaches, as noted by the American College of Radiology 3, 5