In general, laboratory investigations are not indicated in vertiginous patients unless a specific cause for central vertigo is being investigated. With regards to imaging, the question of whether to obtain an emergent CT or MRI should be driven by the specific differential for a particular patient. However, an emergent noncontrast head CT should be obtained in elders, patients who have signs/symptoms of central vertigo (especially cranial nerve or cerebellar findings), hypertension, cardiovascular disease, other stroke risks, coagulopathy (eg, taking warfarin), headache, or intractable or persistent (>72 hours) symptoms. If vertebrobasilar insufficiency (VBI) is a consideration, MRI with MRA (or CT Angiogram) and duplex US of the carotids are indicated. Figure 144-1 illustrates a recommended approach to patients with vertigo.