A 68-year-old man is brought to the emergency department 2 hours after the sudden onset of continuous severe vertigo with nausea and repeated vomiting. He has hypertension treated with ramipril, type 2 diabetes treated with metformin, and a 40 pack-year smoking history. He has no known allergies and is not taking an anticoagulant. He cannot walk unaided and falls to the right when he tries to sit unsupported. On examination, he has spontaneous nystagmus that changes direction with the direction of gaze. The head impulse test is normal on both sides, and the alternate cover test shows a vertical skew deviation. Capillary glucose is 8.2 mmol/L (4.0-11.0, random).
| Heart rate | 84/min |
| Respiratory rate | 16/min |
| Temperature | 36.8 °C |
| O2 saturation | 97%, room air |
| Blood pressure | 168/92 mm Hg |
Question 1 of 57
Which one of the following is the most appropriate next step in management?
Select 1. (0 / 1 selected)
Tip: right-click an answer (or press and hold on a phone) to strike it out. Drag over the question text to highlight it.