Special Imaging Considerations Conventional diagnostic angiography (DA) may be used in a specific subset of patients presenting with episodic vertigo if there is clinical concern for positional insufficiency of the posterior circulation. DA allows for real-time dynamic evaluation of vessel patency in various neck positions, which is difficult to accomplish via conventional CT angiography (CTA) or MR angiography (MRA) imaging. This information may inform subsequent surgical management in these patients [12]. DA also remains the reference standard for confirmation of clinically suspected VBI as well as vertebral artery dissection, both of which can present with vertigo [13,14]. In cases of vertebral artery dissection documented by DA, however, CTA demonstrated a similar sensitivity approaching 100% [14]. The risks of DA include the potential for rare, severe, or life-threatening allergic-like reactions to contrast media, renal injury related to iodinated contrast administration, potential vascular injury, or infarct due to catheter manipulation in the vessels, as well as local complications at the vascular access site to include infection, hematoma, pseudoaneurysm, or arterial occlusion. Transcranial Doppler ultrasound (US) has demonstrated differences in vascular flow parameters between patients with vertigo related to VBI, patients with vertigo unrelated to VBI, and asymptomatic controls, making this a potential diagnostic tool in the characterization of vertigo [13,15]. Brain PET using various radiotracers has shown promise in detecting presymptomatic neuronal dysfunction in patients with certain types of spinocerebellar ataxia (SCA) and in asymptomatic mutation carriers. Changes on PET were detectable sooner than alterations in morphology and signal intensity on conventional MRI. As such, PET may be a valuable adjunct to conventional brain imaging in this patient population [16,17]. OR Discussion of Procedures by Variant Variant 1: Adult. Brief episodic vertigo.
Dizziness and Ataxia. Special Imaging Considerations Conventional diagnostic angiography (DA) may be used in a specific subset of patients presenting with episodic vertigo if there is clinical concern for positional insufficiency of the posterior circulation. DA allows for real-time dynamic evaluation of vessel patency in various neck positions, which is difficult to accomplish via conventional CT angiography (CTA) or MR angiography (MRA) imaging. This information may inform subsequent surgical management in these patients [12]. DA also remains the reference standard for confirmation of clinically suspected VBI as well as vertebral artery dissection, both of which can present with vertigo [13,14]. In cases of vertebral artery dissection documented by DA, however, CTA demonstrated a similar sensitivity approaching 100% [14]. The risks of DA include the potential for rare, severe, or life-threatening allergic-like reactions to contrast media, renal injury related to iodinated contrast administration, potential vascular injury, or infarct due to catheter manipulation in the vessels, as well as local complications at the vascular access site to include infection, hematoma, pseudoaneurysm, or arterial occlusion. Transcranial Doppler ultrasound (US) has demonstrated differences in vascular flow parameters between patients with vertigo related to VBI, patients with vertigo unrelated to VBI, and asymptomatic controls, making this a potential diagnostic tool in the characterization of vertigo [13,15]. Brain PET using various radiotracers has shown promise in detecting presymptomatic neuronal dysfunction in patients with certain types of spinocerebellar ataxia (SCA) and in asymptomatic mutation carriers. Changes on PET were detectable sooner than alterations in morphology and signal intensity on conventional MRI. As such, PET may be a valuable adjunct to conventional brain imaging in this patient population [16,17]. OR Discussion of Procedures by Variant Variant 1: Adult. Brief episodic vertigo.