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A 43-year-old female presents to the emergency department (ED) after she woke up with the sensation that the room was spinning and vomited three times at home. She continues to have significant vertigo when she presents to the ED 4 hours later. Her symptoms are worsened by head movement. She has noticed some unsteadiness but is able to walk unaided. When you examine her, she has left-beating horizontal nystagmus with a slight rotatory component to the left.

A 67-year-old male presents to the emergency department (ED) with a 10-minute history of right upper extremity and right facial weakness, which came on suddenly. His symptoms spontaneously remitted. He has never experienced symptoms like this before. He has a past medical history of coronary artery disease, type 2 diabetes mellitus, dyslipidemia, and is a lifelong smoker. The patient states that he now feels completely well and back to his baseline. On examination, the patient is afebrile. Blood pressure is 160/87, heart rate is 89 in sinus rhythm, and respiratory rate is 16. His oxygen saturation on room air is 94%. Glucose is 5.6 mmol/L. Cranial nerve and peripheral neurological examination are completely unremarkable. Reflexes, coordination, and gait are all within normal limits. Cardiac and respiratory examination are also unremarkable. His electrocardiogram shows normal sinus rhythm.