Which statement about brain imaging in patients with acute dizziness is TRUE?
- In patients with BPPV, a brain MRI can help establish the diagnosis.
- In patients with posterior circulation stroke, the CT is diagnostic in >75% of cases.
- In patients with posterior circulation stroke, early MRI with diffusion-weighted images will establish the diagnosis in nearly all patients.
- In patients with vestibular migraine, neither CT nor MRI is indicated.
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Answer: D. In patients with spontaneous episodic vestibular syndrome, there is no specific test that distinguishes vestibular migraine from posterior circulation TIA, and decision-making must be individualized based on history, epidemiology, and context. In patients with triggered episodic vestibular syndrome who likely have BPPV, no diagnostic testing beyond physical examination is needed. CT scanning is notoriously unreliable for any acute ischemic stroke and is even worse in the posterior circulation. MRI with diffusion-weighted imaging can miss stroke if it is performed in the first 48 hours.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
