Retrospective blinded review of magnetic resonance imaging in patients with central electronystagmography findings.

Objective: To evaluate the magnetic resonance imaging results (MRI) of patients with electronystagmography (ENG) suggestive of central vestibular dysfunction and to determine if MRI abnormalities correlate with ENG findings. Study Design: Retrospective blinded case review. Setting: A regional neurotology center. Patients: Patients with ENG suggesting central vestibular dysfunction were identified (n = 30). An age-matched group of patients with normal ENG results were used as controls (n = 28). Main Outcome Measures: MRI abnormalities in cerebellum, brain stem, cerebellar peduncles, and central ENG findings. Results: Twenty-one patients with abnormal MRI results of the vestibular pathway were found, 15 with abnormal and 6 with normal ENG results. MRI correlation with ENG findings has a better predictive value in older patients than in younger patients. Sixteen patients had MRI evidence of vascular compression, seven of whom had abnormal and nine of whom had normal ENG results. Conclusions: This study suggests that a detailed review of MRI images of the vestibular pathway is warranted, and, in patients with central ENG abnormalities, MRI may support the diagnosis of central vestibular dysfunction. MRI cannot support central vestibular dysfunction caused by vascular compression.