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A 49-year-old man had acute-onset dizziness, vomiting and diplopia. He had taken treatment for HIV infection since 2017, with a CD4 count over 300×106/L (430–1690) and suppressed HIV viral load. His blood pressure was 170/110 mm Hg on presentation though without history of hypertension. On examination, there were cerebellar signs, including bilateral horizontal gaze-evoked nystagmus, dysdiadochokinesia, dysmetria and an ataxic gait. An uncontrasted CT scan of the head identified bilateral cerebellar and brainstem (midbrain, pontine and medullary) haemorrhages, but CT angiogram of the cerebral and neck vessels was normal. We initially diagnosed a hypertensive-related intracranial haemorrhage and admitted him to optimise vascular risk factors and for rehabilitation.
Over the next 48 hours, he …
Contributors AS and LMT contributed equally to the concept design and write-up of the case.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Claire Rice, Bristol, UK.
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