A 60-year-old man with hypeension presents to the emergency depament complaining of veigo, nausea, vomiting and postural instability. His veigo began suddenly 2 hours ago and has been constant.Upon examination, the man cannot walk due to severe instability. The head impulse test is negative. There is left beating nystagmus on left lateral gaze and right beating nystagmus on right lateral gaze. Skew detion is present with quick, veical movements as each eye is uncovered. What is the most likely diagnosis?
Head Impulse test +ve in: Meniere's disease Vestibular neuritis BPPV Based on the clinical findings, the patient is likely to have central veigo. The other options (A,C & D) are causes of peripheral veigo, cerebellar infarction is the only option that might present with central veigo. Veigo Peripheral causes Central causes Nystagmus Unidirectional, horizontal with some torsion nystagmus that beats towards affected side and never change direction. Can change direction & can be in any direction Presence of neurological deficit None Neurological deficits like diplopia, weakness, paraesthesia and dysahria present Postural instability Pt. lean to the affected side lPt. falls randomly and unable to walk.
Meniere's disease
Cerebellar infarction
Vestibular neuritis
BPPV
Stroke and TIA