Effectiveness of Clinical Risk Factors in the Detection of Central Pathology in Patients With Isolated Vertigo.

ABSTRACT

BACKGROUND: There is no clinical guidance for the indications of neuroimaging in patients with isolated vertigo. The differential diagnosis of isolated vertigo can be challenging for emergency physicians. OBJECTIVE: The aim of this study was to identify the risk factors that increase the likelihood of detecting a central pathology in patients who present with isolated vertigo and in whom peripheral vertigo is considered. METHODS: Patients imaged using neuroimaging, including diffusion-weighted magnetic resonance imaging (DW-MRI) with head computed tomography (CT), for isolated vertigo over a 3-year period were identified retrospectively. The patients were divided into two groups-a positive neuroimaging group and a negative neuroimaging group-according to the abnormal lesions in the head CT and DW-MRI results. We reviewed the medical records to identify presenting symptoms and signs, vascular risk factors, history of vertigo, medical comorbidities, and diagnostic imaging results (i.e., head CT and DW-MRI). RESULTS: Two hundred and seventy-nine patients were included 231 in the negative neuroimaging group (82.8%) and 48 in the positive neuroimaging group (17.2%). Univariate and multivariate logistic regression analyses were performed. It was found in the regression analysis that being 65 years or older (odds ratio [OR] 2.53; 95% confidence interval [CI] 1.29-4.96; p = 0.006), having two or more vascular risk factors (OR 2.45; 95% CI 1.10-5.46; p = 0.028), and not responding to the treatment (OR 2.57; 95% CI 1.08-6.14; p = 0.033) increased the likelihood of detecting a pathology in neuroimaging. CONCLUSIONS: We suggest that patients unresponsive to ED treatment, 65 years or older, and with two or more vascular risk factors, should alert physicians for central causes and increase the yield of neuroimaging.