Before we move on, I did want to hit other studies that may be appropriate in a sudden case of the dizzies. None of these tests are in my scope of practice to request or perform (as far as I know), so I’m certainly no expert. BUT I did want to mention these for those that can request or perform these tests.
First of all are the scans: CT scan or MRI. The articles recommend doing a scan of some sort if you have vertigo plus one of the following: new onset occipital headache, central neuro signs or symptoms, sudden deafness, a negative head impulse test. Although CT scan is often the first line scan, in this case and MRI would be more appropriate as CT tends to have a blind spot in the posterior fossa where the cerebellum lies. CT often will miss a cerebellar infarction. MRI doesn’t always get it either, especially if the stroke is particularly new. Which is why the clinical exam needs to supersede scans in importance in this particular case. This has happened in several cases I’ve worked on. The patient shows up the ER with dizziness. Their scans are negative, so they’re sent home. The patient gets worse, so they go back to the ER a few hours or days later and THEN the scan will show something. I don’t know the answer here, but I know sending someone home with an untreated stroke isn’t the answer.
Then is caloric testing with vestibular-evoked myogenic potentials or VeMPs. In my neck of the woods, audiologists do this test. It involves placing surface EMG at the eye muscles and recording their action when different temperature of water is put into the ear canal. I wish I knew how to read these, but I don’t. I also wish I knew what information can be gleaned from them, but I don’t. One of the articles mentioned a bedside caloric test version that doesn’t get as in depth with the VeMPs.
A third article mentioned several other test options:
Diagnosis and initial management of cerebellar infarction as originally seen in The Lancet Neurology
This article mentioned Doppler ultrasound, CT angiography or MRI angiography and catheter angiograms, which all look at the blood flow.
Then there was a small section of other tests as well. “… electrocardiography and some form of echocardiography… are often useful to identify a cardioembolic source. Blood tests to identify the causes of thrombophilia and vasculitis can be done with some patient and other tests such as serum lipids might help with risk stratification for secondary stroke prevention.”
In summary, those tests should be considered as well with cases of sudden dizziness.
I’m currently in the midst of doing a literature review in preparation to write a case report. If you would like more background information on the case or information about the project, please click here. If you would like to see other article reviews related to this project, please click here.