A 53-year-old man non-diabetic and non-hypertensive presented with left tinnitus and imbalance while walking for last 6 months, in addition, he was having feel of cold right hand along with numbness but no weakness or paralytic episode, onset was sub-acute and non-progressive, social drinker left smoking for last 3 years, there is family h/o CAD and father died because of that, he consulted many ENT specialist and GPS also, revealed no local ENT problem put on ginkgo extract tablet & betehistadine with little relief, tab aspirin was added later on based on MRI findings. Exam revealed: pulse 80/min +r BP -130/80 lt, slightly lower in rt upper limb CNS: no cranial nerve palsy, gait ataxia present with the swing towards right on Tandem gait.
Mild restriction of neck movement and there is bruit on auscultation in rt lower neck, other peripheral pulses are normally palpable Investigation:…
