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Posterior circulation stroke presenting as vertigo — SCE Geriatric Medicine MCQ

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HardStroke carePosterior circulation stroke presenting as vertigoSCE Geriatric Medicine

An 85-year-old woman presents with sudden severe vertigo, vomiting and inability to stand. She has hypertension and AF not anticoagulated; examination shows direction-changing nystagmus, dysarthria and right limb ataxia. CT head is normal and symptoms began four hours ago. What is the most important next step?

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Correct answer: D — Treat as posterior circulation stroke and obtain urgent specialist imaging

The best answer is “Treat as posterior circulation stroke and obtain urgent specialist imaging”. Treat as posterior circulation stroke and arrange urgent stroke assessment with MRI or vascular imaging as appropriate The alternatives “Diagnose vestibular neuritis because CT head is normal”, “Discharge with prochlorperazine and falls advice, within a structured care pathway”, “Perform Epley manoeuvre as definitive treatment, after individual risk assessment”, “Delay review until outpatient ENT assessment, with multidisciplinary review” are credible in related presentations but do not match the defining finding, treatment threshold, legal test or care pathway in this stem.

Reference: NICE NG249 falls recommendations: https://www.nice.org.uk/guidance/ng249/chapter/Recommendations