Case 5. Acute vertigo and unsteadiness
Case
A 68 year old man came to hospital via ambulance with severe dizziness.
He had been well that morning, then had sudden onset dizziness while having his lunch. He had vomited several times. His wife then called an ambulance. He had been able to walk to the ambulance but felt unsteady.
He felt terrible, describing the room spinning and making him feel sick. He felt dizzy even lying still, and felt worse if he moved. He preferred closing his eyes to relieve this, though still felt the dizziness with eyes shut. He was not photophobic however, and had no headache. Although the room appeared to be spinning, he didn't have double vision.
His wife confirmed there had been no slurring of speech or facial droop at onset, and he did not report any weakness, clumsiness or sensory disturbance on either side. His ears were not ringing and he hadn't noted hearing loss.
His background included hypertension and high cholesterol. He took medication for both.
On examination:
The examiner instructed him to focus on the bridge of the examiner’s nose - then quickly turned the patient’s head to the left. He temporarily lost focus, his eyes travelling leftward with his head - then his eyes darted rightward to fixate on the bridge of the examiner’s nose again (i.e. a corrective saccade). In contrast, when the patient’s head was quickly turned to the right, he could keep fixation.
The rest of the examination was normal, including:
Where is the lesion?