What is the role of cerebral imaging studies in the workup of vestibular neuronitis?

Updated: Jul 16, 2018
  • Author: Keith A Marill, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Cerebral imaging may be necessary to assess causes of central vertigo.

Possible causes of central vertigo include the following:

  • Cerebellar bleeds

  • Infarcts and tumors

  • Lesions of the brain stem

  • Cerebellopontine angle tumors

  • Multiple sclerosis

Because significant bony artifacts degrade CT images of the posterior fossa, MRI is the preferred imaging modality when available.

Imaging generally is not indicated in patients with isolated vertigo, in those with no history or physical findings that suggest any diagnosis other than vestibular neuronitis, and in those without cerebrovascular disease risk factors. A lower threshold for imaging should be maintained for elderly patients or those with risk factors for cerebrovascular disease. These patients have a higher risk for a central cause of vertigo, even when no other symptoms manifest. In one study, 10% of patients with cerebellar infarction presented with isolated prolonged vertigo suggestive of vestibular neuronitis. [11]

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