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Posterior circulation stroke — MCCQE Part 1 MCQ

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HardDizziness/VertigoPosterior circulation strokeMCCQE Part 1

63-year-old man with atrial fibrillation presents with continuous vertigo, vomiting and inability to walk. He has direction-changing nystagmus and limb ataxia. Which of the following is the most appropriate next step?

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Correct answer: A — Treat as possible posterior circulation stroke and arrange urgent stroke imaging/assessment

Treat as possible posterior circulation stroke and arrange urgent stroke imaging/assessment is best because central signs and vascular risk make stroke more likely than benign vestibular disease. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Posterior circulation stroke can mimic peripheral vertigo.

Reference: Canadian Stroke Best Practices