A 78-year-old man is brought to the emergency department by his daughter because of a diffuse headache and vertigo. There is no history of head trauma. He drinks 1-2 beers daily and occasionally more on weekends. His vital signs are within normal limits. He describes it as a throbbing that localizes to the back of his head, with associated vertigo and mild nausea. he has hypertension, atrial fibrillation, and type 2 diabetes mellitus. Current medications include enalapril, amlodipine, insulin, and warfarin. Noncontrast head CT reveals an acute hemorrhage in the cerebellar vermis without mass effect or midline shift. Which of the following neurologic findings is most likely to be present during this patient's physical examination?

Question

A 78-year-old man is brought to the emergency department by his daughter because of a diffuse headache and vertigo. There is no history of head trauma. He drinks 1-2 beers daily and occasionally more on weekends. His vital signs are within normal limits. He describes it as a throbbing that localizes to the back of his head, with associated vertigo and mild nausea. he has hypertension, atrial fibrillation, and type 2 diabetes mellitus. Current medications include enalapril, amlodipine, insulin, and warfarin.   Noncontrast head CT reveals an acute hemorrhage in the cerebellar vermis without mass effect or midline shift.  Which of the following neurologic findings is most likely to be present during this patient's physical examination?

Quizplus · Accepted Answer

Eductional Objective: Acute lesions to the cerebellar vermis typically cause truncal and gait ataxia due to impaired modulation of the medial-descending motor systems.  Involvement of the lower vermis and the flocculonodular lobe also causes vertigo/nystagmus due to dysregulation of the vestibular nuclear complex.

A 78-Year-Old Man Is Brought to the Emergency Department by His