A 70-year-old man is presented to the emergency department 3 hours after awakening with a first-ever acute vertigo, vomiting, and imbalance in the absence of headache or other focal neurologic or otologic symptoms. He has a history of smoking and hypertension. His vertigo persisted even while sitting upright with his head still.

Due to ataxia, he is unable to walk without assistance. *This case is from the Docplexus Editorial Team for educative purposes only.