For suspected central cause of vertigo, which imaging is most helpful early?

For suspected central cause of vertigo, which imaging is most helpful early?

• A. MRI brain
• B. CT head without contrast
• C. Ultrasound of head
• D. PET scan

Answer: (A)

When vertigo could be coming from a central nervous system problem, you want an imaging study that can reliably reveal acute brainstem or cerebellar injury. MRI brain, especially diffusion-weighted imaging, is the most sensitive test for early acute ischemia and other central lesions, including those in the posterior fossa. It often detects findings that a CT head may miss in the first hours after onset. CT without contrast is fast but less sensitive for early ischemia and posterior fossa pathology. Ultrasound looks at vessels but doesn’t show parenchymal brain injury, and PET is not used for acute evaluation of vertigo. So MRI brain is the most helpful early modality for suspected central vertigo.

When vertigo could be coming from a central nervous system problem, you want an imaging study that can reliably reveal acute brainstem or cerebellar injury. MRI brain, especially diffusion-weighted imaging, is the most sensitive test for early acute ischemia and other central lesions, including those in the posterior fossa. It often detects findings that a CT head may miss in the first hours after onset. CT without contrast is fast but less sensitive for early ischemia and posterior fossa pathology. Ultrasound looks at vessels but doesn’t show parenchymal brain injury, and PET is not used for acute evaluation of vertigo. So MRI brain is the most helpful early modality for suspected central vertigo.