The usefulness of magnetic resonance imaging for acute isolated vertigo patients in the emergency department

OBJECTIVE: The aims of study were to determine how many patients require magnetic resonance imaging (MRI) for a diagnosis of central vertigo among all patients with acute isolated vertigo in the emergency department (ED). MATERIALS and METHODS: We retrospectively analyzed 2671 patients. Diffusion-weighted and T2 MR imaging was performed in all patients with the exception of those with trauma and benign paroxysmal positional vertigo. Patients were divided into three groups according to age (young adult, adult, old). Final diagnosis, MRI findings, and risk factors for central vertigo were evaluated. RESULTS: Among 2671 patients, 23.4% (626) needed MRI to diagnose vertigo of central origin. Of these, 4.6% (122/2671) of patients had confirmed vertigo of central origin, such as cerebral infarction (2.4%, 63/2671) or cerebral vascular accident (0.7%, 19). For the diagnosis of a central cause of acute isolated vertigo in patients in the ED, the sensitivity of MRI was 89.3%, and the specificity was 100%. In both young adult and adult patients, the frequency of central vertigo increased in patients with underlying diseases. CONCLUSION: The utility of MRI may not be high in patients with acute isolated vertigo in the ED under age 65 years unless they have signs or risk factors of cerebral vascular accident.