The Man With The Pain In The Neck
|This 35 y/o white male presented with a chief complaint of vertigo and ataxia. Several days before admission, he had exercised vigorously at his sports club and noticed the acute onset of a left posterior cervical ache which persisted. The night before admission fell asleep in an awkward position on the sofa. He awoke in the middle of the night and got up to go to the bathroom. As he was returning from the bathroom, he yawned and stretched 'vigorously'. Immediately afterwards he had the acute onset of vertigo, nausea, vomiting, and left-sided weakness. He actually said that the weakness "felt rubbery. His gait was clumsy. He experienced tingling in his fingers and toes. He had a left occipital headache. He decided to go back to sleep, but when he awoke the next day, he felt no better and came to the Stony Brook ER.|
In the emergency room, the only abnormal findings were in the neurological examination. There was gaze-evoked nystagmus, left finger-to-nose dysmetria, left heel-to-shin dysmetria, and an ataxic gait with a tendency to fall to the left. An imaging study showed an infarct of the brain.