Investigations

Bedside tests should be used to assess for, and exclude, other potential causes of dizziness. These tests include:

• Blood sugar
• ECG
• Postural blood pressures

Any other specific investigations for vertigo will be guided by the clinical picture, and ED investigations may not be required.

Magnetic resonance imaging (MRI) and MR angiography (MRA) are most sensitive for:

• Brainstem infarcts
• Demyelination
• Inner ear pathology
• Acoustic neuromas

However, MRI is rarely available acutely, and patients with suspected central causes such as intracranial (e.g. cerebellar) haemorrhage should initially undergo an urgent CT scan of the brain.

Neuro-imaging should also be considered in those patients with a clinical picture that is not fully consistent with a peripheral cause. This is especially relevant in patients with associated headache, risk factors for stroke or symptoms lasting more than 48 hours.

Learning Bite

Patients in whom a peripheral aetiology cannot be confidently diagnosed should undergo neuro-imaging. Other investigations are likely to be guided by specialist assessment.