The utility of brain CT scan modality in the management of dizziness at the emergency department: A retrospective single-center study

The Diagnostic Value of Brain CT Scans in Evaluating Dizziness in the Emergency Department: A Retrospective Study

BACKGROUND

Dizziness is a common presenting complaint to emergency departments (ED) worldwide, with causes ranging from benign to life-threatening incidents. Computerized tomography (CT) of the brain remains a common diagnostic tool used by emergency physicians; however, it appears to be of low diagnostic value, especially in patients with normal neurological assessment while carrying multiple negative implications on both the patients and the healthcare systems. Our study aims to evaluate the diagnostic value of brain CT scans in assessing patients presenting to the ED with acute dizziness.

MATERIALS AND METHODS

Retrospective review of medical records of patients presenting with complaints of dizziness to the ED at Salmaniya Medical Complex (SMC) who underwent a brain CT scan from January to June 2023. Collected data included patients' demographic information, presenting complaints, and CT scan results. A multivariable analysis of factors associated with positive CT scans was performed.

RESULTS

A total of 481 participants were enrolled in the study, representing diverse age groups as follows: 18-30 years (12.3%), 31-40 years (15.8%), 41-50 years (17.7%), 51-60 years (22.0%), and those aged over 60 years (32.2%). Among the participants, 56.3% identified as male and 43.7% as female. In terms of head trauma history, 7.1% of participants reported such incidents, while the majority (92.9%) had no history of head trauma. Exploring comorbidities, 43.5% of participants had at least one associated medical condition. Among the 481 study participants, brain CT scans revealed that the majority (93.1%) exhibited unremarkable results. The remaining cases exhibited acute events, including 5.4% with infarcts, 1.1% with hemorrhages, and 0.4% with space-occupying lesions.

CONCLUSION

This study provides evidence of the limited value of brain CT scans in dizzy patients with unremarkable clinical examinations. As for clinicians, it can serve as a steppingstone toward the formulation of a policy and a set of guidelines for requesting brain CT scans in patients presenting to the ED with dizziness. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans in providing valuable findings.

Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination

This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.

Evaluation of Types of Vertigo With Electronystagmography: An Experience From a Tertiary Care Hospital in West Bengal, India

Background Electronystagmography (ENG) is a diagnostic test that measures the electrical activity of the muscles that control eye movements. ENG has the potential to identify the cause of vertigo by assessing the function of the vestibular system. Vertigo can be of two types - peripheral or central. In addition, a combination of peripheral and central types may coexist. Peripheral vertigo is caused by pathology in the inner ear and central vertigo is caused by pathology in the brainstem or cerebellum. Objective This study aimed to evaluate the applicability of ENG in assisting the diagnosis of the type of vertigo in a remote tertiary care center in West Bengal, India. Materials and methods This cross-sectional study was conducted in tertiary care hospital in West Bengal, India. Any patient presenting first time with a complaint of vertigo was approached and recruited for the study after taking written informed consent. We collected demographics and conducted a complete ear, nose, and throat examination, including otoscopy and audiological evaluation. A consensus between two expert otorhinolaryngologists was reached for the categorization of vertigo. Then, ENG was performed to assess the vestibular function to help aid the categorization. Magnetic resonance imaging (MRI) and computed tomography (CT) scans were done in central vertigo patients according to the necessity to diagnose the cause. Data were presented in descriptive statistical terms and categorical data were compared by Chi-square test. Result A total of 84 patients (male 31, female 53) with a median age of 25 years (Q1-Q3: 21-30.25) participated in the study. We found 75% of the patients were complaining of instability, 50% rotatory objective vertigo, 29.76% falling tendency, 22.62% blackout, and 2.38% sinking sensation. The majority of the patients (63%) had two or more symptoms. A total of 68 (80.95%) patients could be categorized into peripheral (46 [54.76%]) and central (22 [26.19%]) types. When we added ENG to the tests, we could categorize all the patients and found that 48 (57.14%) had peripheral, 27 (32.14%) had central, and nine (10.71%) had mixed lesions. Conclusion ENG when used in conjunction with clinical examination, otoscopy, and an audiological examination can help to categorize all patients into peripheral, central, or mixed lesion types of vertigo. Hence, ENG can be an important tool in identifying the type of vertigo and can aid in appropriate treatment decisions.

The Impact of the Angular Head Movement's Velocity during Diagnostic Maneuvers on Proper Benign Positional Paroxysmal Vertigo Diagnosis and Therapy

Based on the current state of the BPPV field, there are no guidelines that specify an angular head movement's velocity (AHMV) during diagnostic maneuvers of BPPV. The aim of this study was to evaluate the impact of AHMV during diagnostic maneuvers on proper BPPV diagnosis and therapy. The analysis covered the results obtained in 91 patients with a positive result of the Dix-Hallpike (D-H) maneuver or the roll test. The patients were divided into four groups based on values of AHMV (high 100-200°/s and low 40-70°/s) and the BPPV type (posterior: PC-BPPV or horizontal: HC-BPPV). The parameters of the obtained nystagmuses were analyzed and compared to AHMV. There was a significant negative correlation between AHMV and latency of nystagmus in all study groups. Furthermore, there was a significant positive correlation between AHMV and both maximum slow phase velocity and average frequency of nystagmus in the PC-BPPV groups, whereas it was not observed in the HC-BPPV patients. Complete relief of symptoms was reported after 2 weeks and was better in patients diagnosed with maneuvers performed with high AHMV. High AHMV during the D-H maneuver allows the nystagmus to be more visible, increasing the sensitivity of diagnostic tests and is crucial for a proper diagnosis and therapy.

Role of cardiovascular computed tomography parameters and lungs findings in predicting severe COVID-19 patients: a single-centre retrospective study

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