Prominent Vertical Nystagmus in Medicine / Internal Medicine — 64yo Man | Neurology | SMLE Q#12017

SMLE Question #12017

Medicine / Internal Medicine Neurology

Objective: OBJ-307

Last updated: February 2026
A 64-year-old man develops sudden gait unsteadiness and slurred speech. He describes oscillopsia and difficulty focusing his eyes. Neurologic examination shows impaired vertical gaze with prominent vertical nystagmus and small, briskly reactive pupils. He has dysarthria and marked limb ataxia on finger-to-nose and heel-to-shin testing, with full strength and intact sensation. These findings are most consistent with a lesion in the territory of which vessel?

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