Value of imaging studies in vertiginous children

Imaging of the head is expensive and can be stressful for children, some of whom need anesthesia for the procedure. The aim of this study was to determine which vertiginous children benefit most from head imaging. We conducted a retrospective chart review of all children aged under 18 years who were referred to the Helsinki University Children's Hospital Radiology Department (tertiary referral center) for head computerized tomography (CT) or magnetic resonance imaging (MRI) over a 1-year period. We analyzed and reviewed the medical records of 87 children who had undergone imaging of the head due to vertigo. Altogether 978 children underwent imaging of the head for various indications. Of these, 87 aged 0–16 years (mean age 8 years) were imaged because of vertigo. Abnormalities were seen in the images of 37 children; 23 were new findings and 14 showed no change in comparison to earlier deviant images. The most common abnormalities in head imaging were brain tumors, infections, multiple sclerosis lesions, and other lesions in T2-weighted images. Of the 23 vertiginous children with a new finding, 19 also had neurological deficits. While four children had no neurological symptoms, three had intense headaches. Head imaging is necessary for vertiginous children with neurological deficits or persistent headaches or who have sustained a head trauma. If vertigo is the only symptom without trauma, imaging studies will not aid diagnostic work-up.