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Central vertigo posterior circulation stroke — ABEM Board MCQ

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HardNeurological emergenciesCentral vertigo posterior circulation strokeABEM Board

A 63-year-old man with hypertension arrives with continuous vertigo and vomiting. Triage acuity is ESI 2; BP 178/96 mm Hg, HR 88/min. He cannot stand, has direction-changing nystagmus, dysarthria, and right limb ataxia. Symptoms began 4 hours ago. Which of the following is the most appropriate imaging study?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — MRI brain with diffusion-weighted imaging and vascular imaging

Central vertigo signs require urgent stroke imaging; MRI with diffusion-weighted imaging is most sensitive for posterior fossa ischemia.

Reference: AHA/ASA stroke guideline; ACEP dizziness guidance