Vertigo
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Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients with recent onset of vertigo.
Date reviewed: July 2014
Date of next review: May 2023
Published: December 2014
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1a |  |
Cavernous Haemangioma Image 1a and 1b (Magnetic Resonance Imaging): Axial and sagittal images demonstrating a cavernous haemangioma in the left cerebellar hemisphere extending towards the vermis. Surrounding high signal intensity indicates oedema. |
| 1b |  |
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Teaching Points
Teaching Points
- Vertigo is a symptom of illusory movement arising from damage or dysfunction of the vestibular system
- A history and detailed neurological examination is important to determine whether the symptoms and signs are suggestive of a peripheral or central cause of vertigo. This will dictate the need for and timing of the imaging
- MRI +/- MRA is generally indicated if a central cause of vertigo is suspected
- If MRI is unavailable or likely to be delayed, a CT scan with fine images of the posterior fossa is a suitable substitute
References
References
Date of literature search: June 2014
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Navi BB, Kamel H, Shah MP, Grossman AW, Wong C, Poisson SN, et al. The use of neuroimaging studies and neurological consultation to evaluate dizzy patients in the emergency department. Neurohospitalist. 2013;3(1):7-14. (Level III evidence)
- Newman-Toker DE, Kerber KA, Hsieh YH, Pula JH, Omron R, Saber Tehrani AS, et al. HINTS Outperforms ABCD2 to Screen for Stroke in Acute Continuous Vertigo and Dizziness. Acad Emerg Med. 2013;20(10):986-996. (Level II evidence)
- Navi BB, Kamel H, Shah MP, Grossman AW, Wong C, Poisson SN, et al. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. Stroke. 2012;43(6):1484-9. (Level III evidence)
- Chen L, Lee W, Chambers BR, Dewey HM. Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit. J Neurol. 2011;258(5):855-61. (Level III evidence)
- Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504-10. (Level II evidence)
- Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183(9):E571-92. (Level I evidence)
- Lee CC, Su YC, Ho HC, Hung SK, Lee MS, Chou P, et al. Risk of stroke in patients hospitalized for isolated vertigo: a four-year follow-up study. Stroke. 2011;42(1):48-52. (Level II evidence)
- Choi K-D, Lee H, Kim J-S. Vertigo in brainstem and cerebellar strokes. Curr Opin Neurol. 2013;26(1):90-95. (Review article)
- Navi BB, Kamel H, Shah MP, Grossman AW, Wong C, Poisson SN, et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc. 2012 ;87(11):1080-8. (Level III evidence)
- Chase M, Joyce NR, Carney E, Salciccioli JD, Vinton D, Donnino MW, et al. ED patients with vertigo: can we identify clinical factors associated with acute stroke? Am J Emerg Med. 2012;30(4):587-91. (Level III evidence)
- Guntinas-Lichius O. Acute vestibular syndrome. N Engl J Med. 1999;340(2):151-2. (Review article)
- Moubayed SP, Saliba I. Vertebrobasilar insufficiency presenting as isolated positional vertigo or dizziness: a double-blind retrospective cohort study. Laryngoscope. 2009;119(10):2071-6. (Level II evidence)
- Bradley WG, Jr. MR appearance of hemorrhage in the brain. Radiology. 1993;189(1):15-26. (Review article)
- Rother J, Wentz KU, Rautenberg W, Schwartz A, Hennerici M. Magnetic resonance angiography in vertebrobasilar ischemia. Stroke. 1993;24(9):1310-5. (Level II evidence)
- Gonzalez RG, Schaefer PW, Buonanno FS, Schwamm LH, Budzik RF, Rordorf G, et al. Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. Radiology. 1999;210(1):155-62. (Level III evidence)
- Lovblad KO, Laubach HJ, Baird AE, Curtin F, Schlaug G, Edelman RR, et al. Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol. 1998;19(6):1061-6. (Level III evidence)
- Lawhn-Heath C, Buckle C, Christoforidis G, Straus C. Utility of head CT in the evaluation of vertigo/dizziness in the emergency department. Emerg Radiol. 2013;20(1):45-9. (Level III evidence)
- Fortnum H, O'Neill C, Taylor R, Lenthall R, Nikolopoulos T, Lightfoot G, et al. The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural history. Health Technol Assess. 2009;13(18):iii-iv, ix-xi, 1-154. (Level I evidence)
- Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope. 2013;123(9):2250-3. (Level III evidence)
- Fiebach JB, Schellinger PD, Jansen O, Meyer M, Wilde P, Bender J, et al. CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke. 2002;33(9):2206-10. (Level II evidence)
- Oas JG, Baloh RW. Vertigo and the anterior inferior cerebellar artery syndrome. Neurology. 1992;42(12):2274-9. (Level IV evidence)
- Amarenco P, Levy C, Cohen A, Touboul PJ, Roullet E, Bousser MG. Causes and mechanisms of territorial and nonterritorial cerebellar infarcts in 115 consecutive patients. Stroke. 1994;25(1):105-12. (Level III evidence)
- Grad A, Baloh RW. Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol. 1989;46(3):281-4. (Level IV evidence)
- Gomez CR, Cruz-Flores S, Malkoff MD, Sauer CM, Burch CM. Isolated vertigo as a manifestation of vertebrobasilar ischemia. Neurology. 1996;47(1):94-7. (Level III evidence)
- Norrving B, Magnusson M, Holtas S. Isolated acute vertigo in the elderly; vestibular or vascular disease? Acta Neurol Scand. 1995;91(1):43-8. (Level II/III evidence)
- Lee W, Chen L, Waterston J. Vertebrobasilar ischaemia presenting as recurrent isolated vertigo. Acta Otolaryngol. 2011;131(8):887-9. (Level IV evidence)
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans Computed Tomography (CT) Angiography Magnetic Resonance Angiography (MRA) |
Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Magnetic Resonance Imaging (MRI) Radiation Risk of Medical Imaging During Pregnancy |
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