A 45-year-old woman complains of sudden dizziness, loss of balance, and difficulty walking. She also mentions a new headache. On examination, she has nystagmus and impaired tandem walking. What are the differential diagnoses and what are the next steps?
This patient's presentation suggests a posterior circulation stroke, possibly affecting the cerebellum or brainstem. Other considerations could include labyrinthitis, vestibular neuritis, or Meniere's disease. The patient needs an immediate noncontrast head CT, and possibly an MRI, to look for evidence of stroke.