The aim of this study was to determine the diagnostic yield of expedited magnetic resonance imaging (MRI) in patients presenting to the Emergency Department (ED) with isolated vertigo without neurologic deficits.

Dizziness accounts for 4% of ED visits nationwide. Vertigo presents a unique clinical challenge as the differential diagnosis spans benign etiologies to life-threatening neurologic emergencies such as posterior circulation strokes. With appropriate training, a neurologic exam that includes Dix-Hallpike and HINTS exams, is more sensitive and specific than MRI in diagnosis of a posterior circulation ischemic stroke.

A retrospective chart review was performed on all patients admitted to our hospital for the diagnosis of vertigo from June 2020 to June 2021. Patients with new, focal neurologic symptoms other than vertigo were excluded. Data collected included vestibular syndrome, documented vertigo exam techniques, head or vascular imaging obtained in the ED, neurology consultation, MRI results, and final diagnosis.

115 patients were included in the study. Of these, 34.7% had a clinical syndrome consistent with acute vestibular syndrome (AVS) and 49.6% with episodic vestibular syndrome (EVS). Only 3 patients had an acute abnormality on MRI. Appropriate vertigo exams were used in 25% of AVS and 26.3% of EVS cases. One patient with AVS and two patients with EVS had acute ischemic strokes (AIS). Of those with AIS, 66% had head imaging prior to admission.

Validation studies demonstrate high specificity and sensitivity of bedside vertigo exams. However, admitting physicians, often internists, may have difficulty in correctly applying and interpreting the appropriate vertigo exam maneuvers for a given vertigo syndrome. Our study demonstrates an overreliance of MRI which has a low yield and high cost for this clinical presentation. Strategies targeting this knowledge deficit with interventions designed to improve exam technique and interpretation may improve patient outcomes and reduce unnecessary admissions for diagnostic testing.