A 70-year-old man is presented to emergency department 3 hours after awakening with 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. Source: Mayo Clinic Proceedings