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EM@3AM: Basilar Artery Occlusion

A 68-year-old male with a past medical history of hypertension, diabetes mellitus, and CAD with a drug eluting stent placed 2 months ago presents with dizziness and vomiting that began 3 hours ago. He has been having “issues with [his] eyes” today and “not feeling quite right.”  Vital signs include BP 165/83, HR 81, RR 18, SpO2 96%. On exam, you notice he has dysarthric speech, limb ataxia, and vertical gaze palsy, which he reports is new. You perform a NIHSS which scores a 3 for mild dysarthria and ataxia in two limbs.