Patient: J.U.
Age: 73
Gender: Male

The patient has a two-week history of nausea and emesis. (He brought a basin with him to the appointment.) He reports general disequilibrium and lightheadedness, preceded by an attack of mild vertigo, which lasted 1.5 days. He was seen in the emergency room, but did not receive any imaging testing. He was given meclazine and an anti-emetic, which he says provides moderate relief.

Subsequent to that initial attack, he has not had vertigo.  His imbalance is not provoked by positional change. He denied any concommittent visual change or hearing change. His gate was noted as being ataxic.

Medical history is significant for hypertension and diabetes.

He does not report any heariang loss, nor hearing or visual changes when the episode of nausea/emesis/disequilibrium began.

• Based on the presenting history and symptoms, what is your prediction on site of lesion, and why do you think so?

Case credits: Case donated by Sam Bittel, AuD, Associated Audiologists, Overland Park, Kansas