Vomiting Vernon's Vertigo

Vernon, a 48-year-old diabetic, hypertensive man, had the sudden onset of vertigo, nausea, vomiting, and tinnitus. His face felt numb on the right side, and his body on the left. When he tried to phone for help, he was unable to dial the phone with his right hand, and could not hear with the phone to his right ear.
 

Examination in the emergency room revealed him to be alert and awake with dysarthric speech and normal mentation. His visual acuity was normal, but the right pupil was 2mm smaller than the left and the right eyelid drooped slightly. The muscles on the right side of his face, including the forehead, were paralyzed. He was deaf in the right ear. There was nystagmus which was maximum on left lateral gaze. Pain and temperature sensation were decreased over the right side of his face and the left side of his body. The right corneal reflex was depressed. The right arm and leg were hypotonic and uncoordinated and demonstrated past pointing, intention tremor, and clumsiness for fine and rapid movements. Muscle strength and deep tendon reflexes were normal, and there were no pathological reflexes.

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