The usefulness of brain imaging studies in dizzy patients presenting to the emergency department (ED) is controversial. We aimed to assess the ‘real-world’ probability of ischemic stroke and other acute brain lesions (ABLs) in these patients to create an algorithm that helps decision-making on whether which and when brain imaging is needed. By reviewing medical records, we identified 610 patients presenting with dizziness, vertigo or imbalance to our university hospital’s ED and receiving neurological workup. We collected timing/triggers of symptoms, ABCD² score, focal neurological abnormalities, HINTS (head impulse, nystagmus, test-of-skew) and other central oculomotor signs. ABLs were extracted from CT/MRI reports. Uni-/multivariate logistic regression analyses investigated associations between clinical parameters and ABLs. Finally, the likelihood of ABLs was assessed for different clinically defined subgroups (‘dizziness syndromes’). Early CT (day 1) was performed in 539 (88%) and delayed MR imaging (median: day 4) in 299 (49%) patients. ABLs (89% ischemic stroke) were revealed in 75 (24%) of 318 patients with adequate imaging (MRI or lesion-positive CT). The risk for ABLs increased with the presence of central oculomotor signs (odds ratio 2.8, 95% confidence interval 1.5–5.2) or focal abnormalities (OR 3.3, 95% CI 1.8–6.2). The likelihood of ABLs differed between dizziness syndromes, e.g., HINTS-negative acute vestibular syndrome: 0%, acute imbalance syndrome with ABCD²-score ≥ 4: 50%. We propose a clinical pathway, according to which patients with HINTS-negative acute vestibular syndrome should not receive brain imaging, whereas imaging is suggested in dizzy patients with acute imbalance, central oculomotor signs or focal abnormalities.

在急诊科（ED）就诊的头昏眼花患者中进行脑成像研究的有用性存在争议。我们旨在评估这些患者中缺血性中风和其他急性脑损伤（ABL）的“现实世界”可能性，以创建一种算法，以帮助做出是否需要何时以及何时需要脑成像的决策。通过回顾病历，我们确定了610例患者出现眩晕，眩晕或失衡，并在我们大学医院的ED中接受了神经系统检查。我们收集了症状的时间/触发因素，ABCD ²得分，局灶性神经系统异常，HINTS（头部冲动，眼球震颤，偏斜测试）和其他中央动眼症状。ABLs从CT / MRI报告中提取。单因素/多因素逻辑回归分析研究了临床参数与ABL之间的关联。最后，针对不同临床定义的亚组（“头晕综合症”）评估了ABL的可能性。539例患者（88％）进行了早期CT检查（第1天），299例患者（49％）进行了MR延迟成像（中位数：第4天）。在318例具有适当影像学检查（MRI或病变阳性CT）的患者中，有75例（24％）发现了ABL（89％缺血性中风）。出现中央动眼症状（赔率比2.8，95％置信区间1.5-5.2）或局灶性异常（OR 3.3，95％CI 1.8-6.2）时，ABL的风险增加。在头晕综合征之间，ABL的可能性有所不同，例如²分≥4：50％。我们提出了一种临床途径，根据该途径，患有HINTS阴性的急性前庭综合征患者不应接受脑部影像学检查，而对于患有急性失衡，中心动眼征兆或局灶性异常的头晕患者建议进行影像学检查。