When is MRI indicated in vestibular disorders and what findings are commonly evaluated?

• A. Indicated when central causes suspected or atypical features; skull MRI assesses brainstem/cerebellar lesions; inner ear MRI assesses vestibular aqueduct and Schwannomas
• B. MRI is never indicated; CT is preferred
• C. Indicated only for pediatric patients; evaluate ear canal
• D. MRI only for acoustic reflex testing

Answer: (A)

The main idea is that MRI is used in vestibular concerns when a central cause is possible or the presentation is atypical, rather than for every routine dizziness case. A skull (brain) MRI with contrast looks for brainstem or cerebellar problems that can produce vertigo or imbalance, such as strokes in the posterior circulation, demyelinating lesions, or tumors in the cerebellopontine angle or along the vestibular pathways. An inner-ear MRI protocol, on the other hand, focuses on the inner ear and the vestibulocochlear nerve, helping detect retrocochlear pathology like vestibular schwannomas (acoustic neuromas) and structural issues such as enlargement or anomalies of the vestibular aqueduct.

So, when central causes are suspected or when there are atypical features, combining brain MRI with a dedicated inner-ear MRI provides a comprehensive look at both central and peripheral structures that could explain the vertigo. This distinguishes imaging needs from routine, peripheral vertigo cases where imaging is often not necessary.