Why not recommend an MRI? What are the keywords that could lead us to recommend an MRI?

It is known that a certain percentage of cases among vertigo patients with apparent peripheral disturbances actually suffer from central vertigo. Especially, vertigo caused by infarction of the posterior inferior cerebellar artery (PICA) territory may sometimes be difficult to diagnose because of the lack of central neurological signs. We encountered a patient with infarction of the area supplied by the PICA who was diagnosed by CT as having peripheral vertigo , but was then eventually definitively diagnosed as a case of infarction of the PICA territory by MRI. In addition to this case report, we conducted a study to determine the key words that led to a request for an MRI to diagnose central vertigo, especially infarction of the PICA territory. We extracted key words relating to these cases from a review of the literature published over the last 25 years; the search identified irregular nystagmus, vomit, stroke risk factors like hypertension, hyperlipidemia, diabetes mellitus and atrium fibrillation, senior citizens, and posterior neck pain as important key words for recommending an MRI for confirming the suspected diagnosis of PICA-territory infarction.