MRI Less Effective at Diagnosing Stroke Than Simple Bedside Exam

MRIs are often equivalent to flushing cash down the toilet.

by Heidi Stevenson

16 October 2009

Modern medicine seems to treat the latest and greatest in technology as the best possible means for diagnosis and treatment, and often does so to the patients' detriment. A case in point is a presentation done today at the American Neurological Association's annual meeting, where investigators discussed a study showing that some strokes can be diagnosed most accurately by a simple bedside exam requiring no special tools.

The simple eye exam correctly diagnosed 100% of strokes presenting with dizziness. In contrast, MRIs used at the same stage were only 88% accurate in diagnosing strokes. The bedside exam did turn up a small percentage of false positives that were actually inner ear problems—1 out of 25, or 4%—while MRIs made no false positive diagnoses.

The bedside exam involves watching the patient's eyes carefully to see if there is abnormal nystagmus, eye oscillations that keep visual images stable as small or sudden head movements occur.

Sbout 5% of patients presenting with dizziness prove to have strokes. That adds up to around 130,000 of the 2.6 million people who go to emergency departments complaining of dizziness each year in the US.

Dr. Newman-Toker, who presented the study, estimates that approximately 50,000 strokes are misdiagnosed every year, and that 20,000 of those misdiagnoses result in disability or death.

Of course, modern medicine takes pride in its technology. Rather that applying simple, humble, and cheap techniques, the call has been for more and more high-tech and dehumanizing methods. The mistaken notion that expensive machinery and separation from patients necessarily provides better outcomes is a myth. As this study documents, the human touch and careful observation might save the lives and quality of life for 20,000 people, if only there hadn't been a mad rush to jump into new and expensive technology.

MRIs are hideously expensive. They can provide remarkable imagery of the body's interior. However, reliance on them, rather that human-to-human methods, has likely resulted in poorer outcomes. Why did the medical world rush headlong into new technologies without first checking to see if they actually outperform the old humble methods? Because the medical world lusted after it's shiny new toys, we're flushing money down the same toilet into which we're tossing the lives and welfare of thousands of people.