Case 24 - Dizziness and slurred speech
Case
A 49 year old man presented with sudden-onset dizziness.
He had been well that morning. Then while out walking his dogs he developed sudden-onset dizziness, describing the world rapidly spinning, and felt unsteady. He was able to remain on his feet and continue to walk. He walked back to his house. There he struggled to use his right hand to operate his keys – his left hand worked normally, whereas his right felt clumsy. He also felt unsteady on his feet, particularly on his right leg.
His wife met him at the door. He was alert, and able to stand, but was slurring his words, but could speak without word-finding difficulties or problems with comprehension.
The spinning sensation passed in under 20 minutes and the speech normalised, though he still felt slightly unsteady. He came to the hospital.
He reported no headache, neck pain, changes to hearing, and no sensory features or weakness. He also reported no hiccups.
The patient had been found to have elevated cholesterol on a routine blood test but had modified his diet as a result. He took no medications and did not smoke or drink alcohol.
On examination he had:
The rest of the examination was normal, including eye movements, speech, and functions in individual limbs.
Where is the lesion?