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This study aims to determine the optimal timing of MRI for detecting posterior circulation stroke in patients with isolated acute-onset continuous dizziness.

May 8, 2026

Abstract Number: Esoc2026a168 Early Versus Late Mri for Detection of Posterior Circulation Stroke in Acute Isolated Continuous Dizziness: Results of the Provide Study

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This study aims to determine the optimal timing of MRI for detecting posterior circulation stroke in patients with isolated acute-onset continuous dizziness.
Part of the multicenter PROVIDE-study with 800 patients recruited from 11 centers in the Netherlands.
Patients underwent early MRI within 48 hours and late MRI after 72 hours if the early MRI was negative.
Centralized review of scans was conducted using 3-mm diffusion-weighted and T2-weighted imaging protocols.
Late MRI was performed in 190 patients after a negative early MRI.
No previously undetected infratentorial infarctions were found; only one new asymptomatic ischemia was detected at late MRI.
The initial negative MRI was likely due to a short symptom duration of less than 24 hours, impacting sensitivity.

Abstract

Abstract Background and aims The optimal MRI timing for detecting posterior circulation stroke (PCS) in patients with isolated acute-onset continuous dizziness (iAOCD) remains uncertain. Although MRI is the preferred imaging modality, up to 20% of PCS may be missed within the first 48 hours after symptom onset, yet supporting evidence remains limited. We assessed the additional diagnostic value of late MRI following a negative early MRI. Methods This analysis is part of the PROVIDE-study, a multicenter prospective cohort including 800 patients with iAOCD recruited from 11 centers in the Netherlands. A subset of patients underwent both an early MRI (48 hours after symptom onset) and a late MRI (72 hours). Late MRI was performed only when the early MRI revealed no central etiology. The imaging protocol included 3-mm diffusion-weighted-imaging and T2-weighted sequences. All scans were centrally reviewed by an experienced neuroradiologist. Results Late MRI was performed in 190 patients with a negative early MRI. No previously undetected infratentorial infarctions were identified. One late MRI showed an acute infarction in a clinically silent region in the right posterior cerebral artery territory. This finding was interpreted as asymptomatic new-onset ischemia rather than as a false-negative early MRI. The negative initial MRI can be explained by the short symptom duration (24 hours), a known factor associated with reduced MRI sensitivity. Conclusions In this prospective cohort of patients with iAOCD, late MRI did not provide additional diagnostic value after a negative early MRI. Clinical decision-making should rely on integrated clinical assessment and MRI, without routine use of late-phase imaging. Conflict of interest Merel Verhagen: nothing to disclose. Adriaan Ros: nothing to disclose. Vincent Klokman: nothing to disclose. Kim Jie: nothing to disclose. Meike Schoenmakers: nothing to disclose. Karlijn de Laat: nothing to disclose. Suzanne Cannegieter: nothing to disclose. Korné Jellema: nothing to disclose.

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Abstract Number: Esoc2026a168 Early Versus Late Mri for Detection of Posterior Circulation Stroke in Acute Isolated Continuous Dizziness: Results of the Provide Study

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