What is the role of imaging in vestibular assessment?

• A. Imaging is used in all cases as the first test
• B. Imaging is used when indicated to evaluate brainstem/cerebellar causes or additional pathology
• C. Imaging is never used in vestibular assessment
• D. Imaging replaces bedside vestibular testing

Answer: (B)

Imaging in vestibular assessment is used selectively, not as a routine first step. The main role is to look for central causes or other pathology when there are red flags or when the history and bedside testing suggest something beyond a peripheral vestibular problem. When indicated, MRI of the brain (especially focused on the brainstem and cerebellum) can reveal strokes, tumors, demyelinating lesions, or other structural issues that could mimic or contribute to vertigo. In acute scenarios, CT may be used to quickly rule out hemorrhage or fractures.

So the best choice reflects that imaging is reserved for when there’s suspicion of central involvement or additional pathology, rather than being performed in every case or replacing bedside vestibular testing.