The Diagnostic Value of Imaging the Patient With Dizziness

Abstract

Even when studying patients with dizziness and asymmetric hearing loss, the probability of identifying a CPA mass is sufficiently low that we do not feel imaging is generally warranted. When faced with a patient with dizziness, we recommend a careful neurologic and otologic examination. If abnormalities are detected on examination that suggest central nervous system disease or invasive otologic disease, imaging should be pursued as appropriate. In cases of acute vertigo, if the patient is at high risk for cerebrovascular disease by virtue of age and additional risk factors, imaging should probably be pursued. For the remainder of patients, if progression of hearing loss is not documented, we do not believe imaging is warranted. Progressive hearing loss with abnormal speech reception thresholds probably warrants a magnetic resonance imaging scan of the internal auditory canals.

Traumatic brain injury and vestibulo-ocular function: current challenges and future prospects

“…The more serious life-threatening central causes of central dizziness are typically identified by imaging, whereas imaging has low sensitivity for peripheral vestibular dysfunction 34. For these injuries, the clinical examination must include a comprehensive history regarding symptoms, identifying risk factors for PCS, which include dizziness, history of migraines, previous concussions, collision-sport participation, female sex, persistent headaches, amnesia, younger age, history of mood disorder, and/or presence of a learning disorder 2,35–37…”

A 69-Year-Old Man With Chronic Dizziness

“…I don't regard computed tomography or MRI as routine unless there are neurologic symptoms or signs, 35 major risk factors for cerebrovascular disease, progressive unilateral hearing loss, or central findings on an electronystagmogram. 36 Gizzi et al 37 estimated that approximately 2500 imaging studies would have to be performed on patients with vertigo to detect 1 cerebellopontine angle tumor. As a routine, a neurologic evaluation is often both more informative and cost-effective, typically costing one eighth to one fourth as much as an MRI, and can yield additional clinical insights.…”

Yield of CT Angiography and Contrast-Enhanced MR Imaging in Patients with Dizziness

“…The diagnostic approach to the patient with dizziness is complex and often combines a detailed history and physical examination with various ancillary tests including the Dix-Hallpike maneuver, orthostatic blood pressure testing, auditory brain stem response testing, posturography, electronystagmography, and imaging, but there is not a unifying consensus on when imaging may or may not be appropriate or even on which specific imaging test should be obtained. [17][18][19][20][21][22][23][24][25][26][27][28][29] Some authors advocate early imaging to exclude a vascular or ischemic basis for vertigo, particularly in patients with thrombotic stroke risk factors, 16 while others argue against the routine use of imaging. [18][19][20][21] Even among those authors who favor early imaging, however, there is no consensus on the type of imaging to be performed.…”

“…[17][18][19][20][21][22][23][24][25][26][27][28][29] Some authors advocate early imaging to exclude a vascular or ischemic basis for vertigo, particularly in patients with thrombotic stroke risk factors, 16 while others argue against the routine use of imaging. [18][19][20][21] Even among those authors who favor early imaging, however, there is no consensus on the type of imaging to be performed. Despite the significant variability in the type of imaging studies performed in the evaluation of patients with dizziness-some of which is undoubtedly due to local biases-an improvement in patient outcomes has yet to be established for any of the various imaging protocols.…”