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Posterior circulation stroke — RCPSC IM MCQ

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HardNeurologyPosterior circulation strokeRCPSC IM

A 67-year-old man presents with continuous vertigo, vomiting, new gait inability, and direction-changing nystagmus. Head impulse testing is normal. Non-contrast CT head is normal. He has atrial fibrillation and is not anticoagulated. What is the most appropriate next step?

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Correct answer: D — Admit for urgent MRI and posterior circulation stroke assessment

Acute vestibular syndrome with central HINTS features and inability to stand is concerning for posterior circulation stroke despite a normal early CT. Urgent stroke assessment and MRI/vascular imaging are required.

Reference: Canadian Stroke Best Practices