Paroxysmal tilt illusion after blinking-an unusual form of stroke manifesting with parietal vertigo

A man in his 70s had an episode of vertical visual tilt after blinking, as if the room tilted to the right, and of deviation of the body to the right when he walked, together with slight vertigo and nausea. He was initially suspected to have a transient ischaemic attack and was investigated with neuroradiology, telemetry and echocardiography.Neurological examination showed horizontal saccadic eye movements and deviation to the right with the Unterberger's test. Brain MRI revealed a minor stroke in the right parieto-occipital junction and an older, smaller infarction in the right cerebellum. There was only slight intimal atherosclerosis, and no cardiac abnormality was found. The stroke was classified as an embolic stroke of undetermined source.Distinguishing central from peripheral lesions when symptoms are transient and discrete is challenging. Emergent brain MRI in patients with subtle subjective visual vertical tilt and vertigo can identify acute parieto-insular ischaemia.