Value of Head CT Scan in the Emergency Department in Patients with Vertigo without Focal Neurological Abnormalities

Background: Vertigo is a common symptom and reason for admission to the emergency department (ED).

Aim: This research aimed to determine the incidence of clinically significant findings on computed tomography (CT) in patients with vertigo without focal neurological abnormalities in the ED.

Material and methods: The results of the native CT scans in the ED were retrospectively analysed. Exclusion criteria included: focal neurological abnormalities, underlying malignancy, brain metastasis, previous brain operation, headache, fever, nausea, vomiting, head trauma, coagulopathy. As a clinically significant finding, we took into an account tumour, haemorrhage and acute ischemic lesion. 72 patients fulfilled the set criteria, present vertigo, without focal neurological abnormalities. Out of 72 patients with a median age of 62 (23-87) years old, 54% of the patients were female, and 46% were male.

Results: Normal CT findings were found in 44 patients (61.1%), 28 patients (38.9%) had pathological findings, out of that number 23 (31.9%) findings were clinically irrelevant and 5 (6.9%) were clinically significant. Out of the 5 clinically significant findings, tumour process was found in 3 (4.2%) patients, haemorrhage was found in 1 (1.4%) patient, and the ischemic lesion was found in 1 (1.4%) patient. Additional evaluation of five clinically significant findings showed a change of initial diagnosis in one case, but the significance of the finding remained the same.

Conclusion: Our study demonstrates a low diagnostic yield of head CT examination with 6.9% of clinically significant findings in patients with vertigo without focal neurological abnormalities.