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Posterior circulation stroke — MCCQE Part 1 MCQ

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HardDizziness/VertigoPosterior circulation strokeMCCQE Part 1

A 66-year-old man with diabetes presents with continuous vertigo, vomiting and unsteady gait for 9 hours. He has horizontal nystagmus, dysarthria and cannot walk unaided. Head impulse testing is normal, and finger-nose testing is impaired on the right. What is the most likely diagnosis?

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Correct answer: B — Posterior circulation stroke

Continuous vertigo with dysarthria, limb ataxia, severe gait impairment and a normal head impulse test is concerning for posterior circulation stroke. Vestibular neuritis can cause continuous vertigo but should not cause dysarthria or limb ataxia. BPPV is episodic and positional rather than continuous with focal neurological signs.

Reference: Canadian Stroke Best Practices; MCC Objectives—Dizziness/Vertigo