Acute Vertigo of Undetermined Origin: Diagnostic Value of Magnetic Resonance Imaging of the Brain

Abstract

Purpose: Vertigo is a common symptom that neurologist and otologist are confronted with. It is a standard situation in the emergency room that in patients complaining of isolated vertigo the origin of the symptom cannot be identified, despite a series of intensive neurological and otological examinations, including cranial CT. MRI is a more reliable tool than CT for the imaging of central vestibular structures. However, the routine use of MRI in these patients has been questioned because it is costly and time-consuming. The purpose of the present study is to (1) determine the diagnostic yield of MRI in patients with acute vertigo and uncertainty as to the central or peripheral origin after neurological, otological, and CT examinations, (2) identify the most common cause of central vertigo identified by MRI in this setting, and to (3) describe clinical characteristics of patients with vertigo of unknown cause (VUC). Design: Retrospective, comparative, consecutive case series. Methods: With the keyword Schwindel (the word for vertigo in German), we searched the discharge summaries of all inpatients admitted between January 1st, 2002 and June 30th, 2005 to the Department of Neurology, Charité Medical University Hospital, Campus Benjamin Franklin in Berlin. A total of 1205 patients were identified. After a hand-search, 108 patients were selected using the following criteria: (1) Chief complaint was acute vertigo, (2) no new obvious neurological symptoms or signs occured such as limb weakness, facial paralysis, ophthalmoplegia, dysarthria, hemianopia, aphasia, or unconsicouness (unspecific or only subjective neurological symptoms such as remittent local paraesthesia did not lead to exclusion), (3) slight ear symptoms such as ringing or numbness could coexist, but none that could be diagnosed by the ear-nose-throat department as symptoms of a definite peripheral origin, (4) history, clinical symptoms and signs did not suggest vertigo origin, (5) head CT on admission did not reveal origin of vertigo, and (6) cranial MRI examination during period of hospitalization. After MRI examination, these patients were divided into group 1 (central vertigo) and group 2 (vertigo of unknown cause, VUC). The patients' medical record was reviewed in detail, and clinical and laboratory data were collected.

Schwindel ist ein häufig auftretendes Symptom. Oft kann nach kompletter klinscher neurologischer und Hals-Nasen-Ohren-ärztlicher Untersuchung sowie nach einem kraniellen Computertomogramm nicht sicher zugeordnet werden, ob es sich um eine peripher-verstibuläre oder um eine zentral-nervöse Störung handelt. Die vorliegende Arbeit untersucht (1) wie oft sich in der kernspintomographischen Untersuchung frische Läsionen darstellen lassen, (2) welche die häufigsten Ursachen für Schwindel zentraler Genese bei diesen Patienten darstellt und soll (3) die klinischen Charakteristika der Patienten mit Schwindel unklarer Genese darstellen. Dazu wurden retrospektiv die Unterlagen der mit der oben beschriebenen Konstellation stationär aufgenommenen Patienten untersucht. Von Januar 2002 bis Juni 2005 wurden 108 Patienten identifiziert. Bei 12% der Patienten wurden erklärende frische Läsionen in der Kernspintomographie gefunden; alle waren ischämischer Genese. Diese Patienten unterschieden sich klinisch und epidemiologisch nicht von den Patienten ohne Läsionsnachweis. Lediglich ein Trend zu häufigeren psychopathologischen Symptomen und Migräne war bei der letzteren Gruppe auffällig.