Brain Computed Tomography (CT) findings in Patients with Vertigo and without Focal Neurological Abnormalities in the Emergency Department of a Tertiary Center in Saudi Arabia: A Retrospective Study

Background: Vertigo is a frequent emergency department (ED) presentation, yet the utility of non-contrast brain computed tomography (CT) in patients without focal neurological deficits remains uncertain. Objective: To assess the diagnostic yield of non-contrast brain CT in adult ED patients presenting with isolated vertigo and no focal neurological signs. Methods: A retrospective cross-sectional study was conducted at a tertiary ED in Riyadh, Saudi Arabia, from January 2021 to October 2024. Adult patients presenting with vertigo and a normal neurological exam who underwent non-contrast brain CT were included. Clinical and demographic data were analyzed to determine the prevalence and predictors of positive CT findings. Results: Among 1,206 patients, only 43 (3.6%) had any positive CT findings. Most abnormalities were chronic or non-acute: space-occupying lesions (46.5%) and signs of idiopathic intracranial hypertension (39.5%). Acute pathology—defined as infarction or hemorrhage—was identified in just 6 cases (0.5%), all in patients with at least one cardiovascular risk factor. No acute findings occurred in patients without hypertension, diabetes, or dyslipidemia (n=446; 0%). Conclusion: The diagnostic yield of non-contrast brain CT in isolated vertigo without focal deficits is extremely low, particularly in patients without vascular comorbidities. Imaging decisions should be guided by risk stratification, reserving CT for patients with cardiovascular risk factors or concerning clinical features. A selective imaging strategy may reduce unnecessary testing and optimize resource use without compromising patient safety.