In a patient with the acute vestibular syndrome, the presence of anisocoria strongly suggests which of the following diagnoses?
- Cerebellar infarct
- Cerebellar hemorrhage
- Lateral medullary infarct
- Midbrain infarct
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Answer: C. A finding of anisocoria suggests a lateral medullary infarct. Any new abnormality found during the targeted neurological examination indicates a central finding, which would be inconsistent with neuritis. Other findings suggestive of posterior fossa stroke include the presence of limb ataxia, dysarthria, diplopia, ptosis, facial sensory loss (to pain/temperature), and unilateral decreased hearing.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
