Sudden onset vertigo: Imaging work-up

Vertigo and dysequilibrium are a frequent cause of medical consultation. Clinical evaluation is essential. Some cases of vertigo are diagnosed clinically while others require imaging, sometimes emergently (suspected stroke). MRI is the imaging modality of choice to assess the labyrinth (labyrinthitis? labyrinthine hemorrhage?), internal auditory canal (vestibular schwannoma? other tumor? ... ) and brain parenchyma including all structures of the auditory pathways: vestibular nuclei, vestibulocerebellar tract, tracts involved with ocular motricity, vestibular cortex ... Multiple central etiologies exist: stroke, multiple sclerosis, tumor ... However, some etiologies are best depicted with CT, especially lesions of the labyrinth: cholesteatoma, trauma, suspected dehiscence of the superior semicircular canal, suspected labyrinthine fistula ... Finally, imaging may be negative (Benign Paroxysmal Positional Vertigo, Meniere's disease, vestibular neuritis, migraine ... ), merely reducing the differential diagnosis. (C) 2011 Elsevier Masson SAS and Editions francaises de radiologie. All rights reserved.