A 73-year-old man presented with sudden onset severe dizziness, nausea, and diplopia after he had an episode of intense coughing. He had a history of hypertension, chronic obstructive pulmonary disease (COPD) and pacemaker for 2nd degree AV block. No history of trauma, neck manipulation or pain was reported.
The patient stated that he often coughed to free his airway and also had difficulty in swallowing food for one year. Clinical examination on presentation: Conscious (Glasgow coma score of 15) Slightly aphonic Slight anisocoria right > left in cranial nerve examination Vertical and horizontal nystagmus Diplopia His dizziness improved when he laid down with closed eyes Paraesthesia in the left arm Positive left-sided finger-nose test Positive left-sided dysdiadochokinesis Difficulty in standing up from a seated position Stretched arm test - deviation of the left arm to the left CT…
