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Posterior circulation stroke — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsPosterior circulation strokeSCE Acute Medicine

A 69-year-old man is assessed on the acute medical unit. He has acute vertigo, diplopia, dysarthria and limb ataxia. Head impulse test is normal and vascular risk is high. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: E — Posterior circulation stroke

Posterior circulation stroke is the best answer because brainstem signs with acute vestibular symptoms point to posterior circulation stroke rather than benign vestibular neuritis. Encephalitis is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Early CT may be insensitive for posterior fossa infarction.

Reference: NICE NG128