Central Vertigo — Emergency Diagnosis and Stroke Treatment in Hyderabad at KIMS

A normal CT scan in the posterior fossa does not exclude a stroke. The cerebellum and brainstem are surrounded by dense bone that creates artefact on CT, making small ischaemic strokes invisible. CT is primarily useful for detecting bleeding (haemorrhage), not ischaemia, in the posterior fossa. MRI — specifically diffusion-weighted imaging (DWI) — is the correct test for posterior fossa ischaemic stroke. Even MRI DWI can miss up to 20% of posterior fossa strokes in the first 24 hours, which is why the clinical examination (particularly the HINTS exam performed by the neurologist) is so important. Keeping your husband for observation and MRI is absolutely the right decision. A posterior fossa stroke that is missed can lead to: basilar artery thrombosis (which can be fatal) · Cerebellar oedema with herniation · A second, larger stroke in the following 48–90 hours. Please do not request early discharge. Call 040-44885000.

Yes — this combination of recurrent brief episodes of vertigo with double vision is a very high-risk presentation for vertebrobasilar TIA (transient ischaemic attack in the posterior circulation). The combination of at least two posterior circulation symptoms (vertigo + diplopia) is highly specific for TIA rather than benign peripheral vertigo. After a TIA, the risk of a completed stroke is approximately 5–10% within the next 48–90 days, and the risk is highest in the first 48–72 hours. Your mother needs an urgent assessment at KIMS: MRI brain + MRA posterior circulation (to look for basilar artery stenosis, vertebral artery stenosis, or dissection) + ECG and Holter monitoring (for atrial fibrillation) + echocardiography + blood tests. She should start aspirin now (if not contraindicated) and should not drive. Call 040-46324365 for an emergency neurology assessment today.

A change in the character of the vertigo — from brief, position-triggered spinning that responded to the Epley manoeuvre to constant, non-positional vertigo that does not respond to the Epley — is an important red flag that requires re-evaluation, not repeat Epley manoeuvres. Constant, non-positional vertigo is NOT consistent with BPPV. Possible causes include: vestibular neuritis (new episode) · Menière's disease (particularly if associated with hearing change or ear fullness) · Central vestibular pathology (brainstem or cerebellar lesion) · Autoimmune inner ear disease · Perilymphatic fistula · Superior semicircular canal dehiscence. At KIMS, the neurological examination (including HINTS exam) + audiometry + VNG + MRI will identify the correct diagnosis. The HINTS exam is particularly important to exclude a central cause. Call 040-44885000.

Vertebrobasilar insufficiency (posterior circulation TIA) is a significant risk for driving because the episodes can cause sudden dizziness, double vision, or loss of coordination without warning — any of which can cause a road accident. In India, the legal framework for driving with TIA is evolving, but the clinical guideline at KIMS follows international standards: a minimum of 4 weeks episode-free before driving resumes after a TIA, provided the underlying cause has been identified and treated (antiplatelet therapy, statin, BP control, and any identified cardiac cause managed). If vertebral or basilar artery stenosis is significant and ongoing, or if AF is present, the duration before safe driving may be longer. Your father should discuss this explicitly with his neurologist at KIMS, who will advise based on the frequency and nature of his episodes, the imaging findings, and the treatment response. Call 040-44885000.