Abstract
Dizziness is a common reason for ED visits, posing diagnostic challenges due to its broad range of potential causes, from benign vestibular conditions to critical cerebrovascular events. Although CT scans are often used to quickly assess for intracranial hemorrhage, MRI provides greater accuracy for identifying strokes in the posterior circulation. Differences in imaging practices and uncertainty about the most effective approach highlight the need for a thorough evaluation of these modalities. This narrative systematic review examined the diagnostic performance of MRI and CT in assessing patients presenting with acute dizziness in ED settings, focusing on detection rates and clinical considerations. A comprehensive literature search was conducted, and eight relevant studies were included. The methodological quality of the studies was assessed, and findings were synthesized narratively due to variability in study designs. Overall, MRI showed a higher detection rate for underlying causes of dizziness compared to CT, particularly for posterior circulation strokes. CT was mainly useful for ruling out hemorrhage, while MRI offered superior detection of ischemic events. Using clinical factors such as age, vascular risk, and neurological findings may help prioritize MRI use in patients with higher stroke risk, supporting targeted imaging strategies to improve diagnostic outcomes and resource utilization.