34 year old man with headache, vertigo, clumsiness, and unsteady vision
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Abstract
The patient described having had headaches since childhood, which characteristically got worse with activities such as coughing, sneezing, choking, postural changes, and Valsalva, and which were sometimes associated with vertigo. During an episode of sneezing with vertigo 3 years prior to presentation, he fell to the floor and had difficulty arising. At that time, he was evaluated with a head CT and ateriogram, which were found to be unremarkable. The headaches were described as occipital in location, with an associated neck pain that prompted him to see a chiropracter. During the year prior to presentation, a bidirectional vertical oscillopsia developed.
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