Author: John Whittaker / Editor: John Whittaker / Reviewer: Joe Schrieber / Codes: CAP5, CAP12 / Published: 06/02/2021

A 49-year-old man is brought to the ED by ambulance after waking this morning with severe vertigo. He is unable to move his head, sit or stand without feeling very nauseous and has, in fact, vomited a number of times. He has not noticed any alteration in his hearing or tinnitus. He has no other symptoms, in particular no visual or speech problems and no limb weakness.

He was well yesterday and has not suffered any recent illness or injury. The patient is normally fit and well and doesn’t take any regular medication. He drinks little alcohol but he has smoked 10 cigarettes per day for the last 25 years.

His initial observations are pulse 78 / minute and regular, BP 166/85, respiratory rate 14 / minute, oxygen saturation 96% on air. His temperature is 36.5oC.