/ 439 = Abstract = Diffusion-weighted Imaging in Isolated Vertigo Patients Having Risk Factors for Stroke Hyung Goo Kang, M.D., Yu Sang Yun, M.D., Jin Hee Yi, M.D., In Cheol Park, M.D., Kyeong Ryong Lee, M.D., Sang Won Chung, M.D.*, Hong Du Goo. M.D.*, and Seung Ho Kim, M.D. Department of Emergency Medicine, Yonsei University College of Medicine, Department of Emergency Medicine, Ilsan Hospital* Background: The management of vertiginous patients is a great challenge to emergency physicians. We evaluated the diagnostic value of a diffusion-weighted image(dwi) in differentiating central vertigo from the peripheral vertigo in patients who presented no neurological symptoms other than risk factors for stroke. Methods: From March 2000 to February 2001, we retrospectively analyzed the cases of 68 patients who visited the emergency department with symptoms of isolated vertigo and who had risk factors for stroke. DWIs, computed tomograms(ct), and medical records were reviewed, and the final diagnose, the DWIs and the CT readings, the risk factors for stroke, and the time it took waiting for a DWI or CT scan were analyzed. R e s u l t s: Of the 68 patients, 21(30.8%) had central vertigo: 15 vertebrobasilar transient ischemic attacks(vb-tia), 4 brain stem infarctions, 1 cerebellar infarction, and 1 cerebellopeduncular infarction. The DWI showed a 28.6% sensitivity, a 97.9% specificity, and an 85.7% positive predictive value in diagnosing central vertigo. It also had a 100% sensitivity in detecting infarctions. Conclusion: A DWI had a comparable sensitivity to MRI in detecting central vertigo and small, but potentially, lethal infarctions in our patient population. We recommend clinical application of DWI in the emergency department evaluation of isolated vertigo patients with risk factors for stroke. Key Words: Vertigo, Diffusion weighted imaging(dwi), Risk factor for stroke Tel : 02) 361-5790, Fax : 02) 392-3715, E-mail : edksh@yumc.yonsei.ac.kr
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/ 445 01. Olieira-Filho J, Ay H, Schaefer PW et al: Diffusion weighted magnetic resonance imaging identifies the clinically relevant small penetrator infarcts. Arch Neurology 57;1009-1014, 2000. 02. Lansberg MG, Albers GW, Beaulieu C, Mark MP:
446 / Comparison of diffusion-weighted MRI and CT in acute stroke. Neurology 54;1557-1561, 2000. 03.,, :. 9;420-429, 1998. 04. Baloh RW: Vertigo. The Lancet 352 ; 1841-1846, 1998. 05. Hotson, JR, Boloh RW: Current Concepts: Acute vestibular syndrome. N England J Med 339; 680-685, 1998. 06. Martin PJ: Vertebrobasilar ischemia. QJM 91;799-811, 1998. 07. Barth A, Bogousslavsky J, Regli F: The clinical and topographic spectrum of cerebellar infarcts: A clinical magnetic resonance imaging correlation study. Annals of Neurology 33;451-456, 1993. 08.,, 39;21-27, 1998. 09. Albers GW: Diffusion-weighted MRI for evaluation of acute stroke. Neurology 51;S47-S49, 1998. 10. Moseley ME, Cohen Y, Mintorovitch J. et al: Early detection of regional cerebral ischemia in cats: comparison of diffusion and T2 weighted MRI and spectroscopy. Magn Reson Med 14;330-346, 1990. 11. Froehling DA, Silverstein MD, Mohr DN, Beatty CW: Does this dizzy patient have a serious form of vertigo? JAMA 271;385-388, 1994. 12. Mcdonell GV, Esmonde TF, Kerr A: Dizziness: Neurology and ENT approaches compared. J Neurol Neurosurg & Psychiatry 67;266, 1999. 13. Baloh RW: Differentiating between pheripheral and central causes of vertigo. O t o l a r y n g o l o g y - Head & Neck Surg 119;55-59, 1998. 14. Berkowitz BW: Matutinal Vertigo: Clinical characteristics and possible management. A r c h Neurology 42;874-877, 1985. 15.,,, : 41;175-178, 1999.. 7;540-544, 1996. 16. Kingsley DPE, Radue EW, Du Boulay EPGH: Evaluation of computed tomography in vascular lesions of the vertebrobasilar territoty. J Neurol Neurosurg Psychiary 43;193-197,1980. 17., : MRI. 14;810-823, 1994. 18.,, :. 39 ; 901-906, 1998. 19. Norrving B, Magnusson M, Holtas S: Isolated acute vertigo in the elderly; Vestibular or vascular disease? Acta Neurol Scand 91;43-48, 1995. 20. Kidwell CS, Alger JR, Salle FD et al: Diffusion : : MRI in patients with transient ischemic attacks.. Stroke 30;1174-1180, 2000. 21.,,,,, : MR. 43;17-23, 2000. 22. Schaefer PW: Diffusion-weighted imaging as a problem-solving tool in the evaluation of patients with acute strikelike syndromes. Topics in Magnetic Resonance Imaging 11;300-309, 2000. 23. Ay H, Buonanno FS, Rordorf G et al: Normal diffusion-weighted MRI during stroke-like deficits. Neurology 52;1784-1792, 1999. 24. Schellinger PD, Jansen O, Fiebach JB, Hacke, Sartor K: Standardized MRI Stroke Protocol comparison with CT in hyperacute intracerebral hemorrhage. Stroke 30:765-768, 1999. 25. Italo L, Rafael HL, Louis RC, Steven W: MRI Features of intracerebral hemorrhage within 2 hrs from symptom onset. Stroke 30;2263-2267, 1999. 26. Maeda M. Abe H, Yamada H, Ishii Y: Hyperacute infarction: a comparison of CT and MRI, including diffusion-weighted imaging. N e u r o r a d i o l o g y