Neuroimaging utilization and clinical indications in geriatric patients presenting to the emergency department with dizziness

Abstract

Background & Objective: With the increasing prevalence of advanced technology, there has been a notable rise in the use of neuroimaging for patients presenting to the emergency department (ED) with dizziness in recent years. This study aims to investigate the frequency of neuroimaging, the clinical indications for its use, the findings, and the factors influencing these findings in geriatric patients presenting with dizziness to the ED.

Methods: The study included patients aged 65 and older who presented to the ED with dizziness between January 1, 2018, and December 31, 2023, and who had undergone brain computed tomography (CT) and/or diffusion-weighted magnetic resonance imaging (DW-MRI), with complete data available. Intracranial masses, acute-subacute ischemic findings, intraparenchymal and subarachnoid hemorrhage, and brain edema detected on brain CT were classified as significant pathologies. Additionally, patients were compared based on the presence of ischemia on DW-MRI with other variables.

Results: The study included 508 patients who underwent CT scan and/ or DW-MRI. Significant pathology was detected in 6.3% of those who underwent CT scan. Among the patients who underwent DW-MRI, 9.1% were found to have acute-subacute ischemia. The incidence of significant pathology and ischemia was statistically higher in patients who underwent CT scan and DW-MRI due to indications such as aphasia, focal neurological deficits, vertical nystagmus, ataxia, and dysmetria/dysdiadochokinesia (p<0.05).

Conclusion: In geriatric patients, emergency neuroimaging should be performed considering clinical characteristics and risk factors. Limiting the use of CT scan to specific indications rather than routine use, and prioritizing DW-MRI in cases where ischemic events are suspected, may be more appropriate.