Accordingly, diagnostic yield of CT head in patients presenting with vertigo is low [40]. Hearing Loss and/or Vertigo CTA Head and Neck There is no evidence to support use of CTA in patients presenting with peripheral causes of vertigo. In patients with episodic vertigo that cannot be confidently categorized as peripheral, CTA can be used to detect underlying vertebrobasilar insufficiency [41]. MRI Head and Internal Auditory Canal Based on clinical assessment, peripheral vertigo in many patients is presumed to be secondary to benign processes such as benign paroxysmal positional vertigo or Meniere disease, and these patients are often managed successfully without images are capable of delineating endolymphatic sac, and delayed 3-D FLAIR images can demonstrate hydrops associated with Meniere disease following IV or intratympanic contrast administration as contrast accumulates in perilymphatic but not endolymphatic space. However, the role of such studies in management of these patients is still not clearly established [42-53]. IV contrast can be helpful in showing enhancement of vestibule or semicircular canals in patients with labyrinthitis. MRI of the brain can be used to detect rare but significant central causes of vertigo in cases where distinction between peripheral and central categories is not clinically evident [54]. MRA Head and Neck There is no evidence to support use of MRA in patients presenting with peripheral causes of vertigo. In patients with episodic vertigo that cannot be confidently categorized as peripheral, MRA without and with IV contrast can be used to detect underlying vertebrobasilar insufficiency [55]. MR Venography Head There is no evidence to support use of MRV in the initial workup of patients presenting with vertigo; however, in patients who may have vertigo as a symptom of pseudotumor cerebri, MRV may show narrowing of the transverse sinuses. Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.
Hearing Loss and or Vertigo. Accordingly, diagnostic yield of CT head in patients presenting with vertigo is low [40]. Hearing Loss and/or Vertigo CTA Head and Neck There is no evidence to support use of CTA in patients presenting with peripheral causes of vertigo. In patients with episodic vertigo that cannot be confidently categorized as peripheral, CTA can be used to detect underlying vertebrobasilar insufficiency [41]. MRI Head and Internal Auditory Canal Based on clinical assessment, peripheral vertigo in many patients is presumed to be secondary to benign processes such as benign paroxysmal positional vertigo or Meniere disease, and these patients are often managed successfully without images are capable of delineating endolymphatic sac, and delayed 3-D FLAIR images can demonstrate hydrops associated with Meniere disease following IV or intratympanic contrast administration as contrast accumulates in perilymphatic but not endolymphatic space. However, the role of such studies in management of these patients is still not clearly established [42-53]. IV contrast can be helpful in showing enhancement of vestibule or semicircular canals in patients with labyrinthitis. MRI of the brain can be used to detect rare but significant central causes of vertigo in cases where distinction between peripheral and central categories is not clinically evident [54]. MRA Head and Neck There is no evidence to support use of MRA in patients presenting with peripheral causes of vertigo. In patients with episodic vertigo that cannot be confidently categorized as peripheral, MRA without and with IV contrast can be used to detect underlying vertebrobasilar insufficiency [55]. MR Venography Head There is no evidence to support use of MRV in the initial workup of patients presenting with vertigo; however, in patients who may have vertigo as a symptom of pseudotumor cerebri, MRV may show narrowing of the transverse sinuses. Variant 7: Persistent vertigo with or without neurological symptoms (central vertigo). Initial imaging.