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A negative non-contrast CT is insufficient to exclude a cerebellar infarct
  1. Jonathan Edlow
  1. Emergency Medicine, BIDMC, Boston, Massachusetts, USA
  1. Correspondence to Dr Jonathan Edlow, Emergency Medicine, BIDMC, Boston, Massachusetts, USA; jedlow{at}

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Sometimes, strict application of ‘evidence-based’ medicine can yield conclusions that are either wrong, clinically misleading and/or harmful. Regarding the conclusion of the recent short-cut review about the accuracy of non-contrast brain CT in diagnosing cerebellar infarction,1 I strongly disagree that there is insufficient evidence that CT can or cannot exclude the condition in ED patients with ‘concerning features’ of vertigo.

In fact, there is abundant evidence that CT should never be used to rule out cerebellar infarction in these patients. Why does my conclusion differ from that of the authors of a technically well-done short-cut review?

First, when the quality or quantity of direct evidence is insufficient, indirect evidence becomes more important, and when results from multiple sources of indirect evidence all point in the same direction, their collective impact becomes stronger.

One single-centre, single blinded (the people interpreting the scans were unaware of the clinical information) comparison of CT and MRI with diffusion-weighted imaging studied 356 …

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  • Contributors The author wrote the letter and is responsible for it.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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