A 78-year-old male presents with acute onset of vertigo, nausea, and unsteadiness. He has horizontal nystagmus that beats towards the left. The head i...

Question

A 78-year-old male presents with acute onset of vertigo, nausea, and unsteadiness. He has horizontal nystagmus that beats towards the left. The head impulse test is positive on the right (corrective saccade when the head is turned to the right). He has no other neurological signs. What is the most likely diagnosis?

Accepted Answer

Right-sided vestibular neuritis - a peripheral cause; the positive head impulse test towards the affected side is reassuring

Answer

Bilateral vestibular failure

Answer

Central positional vertigo

Answer

Left cerebellar stroke - urgent CT is needed

Answer

Posterior inferior cerebellar artery (PICA) occlusion

uk-dipimc MCQ (SBA): HINTS Examination - Peripheral Vertigo