“The room won’t stop spinning”

The classic and dangerous SCA/clinical trap: acute vertigo mislabelled as benign "ear crystals/labyrinthitis" when it is a posterior-circulation stroke. The discriminators: BPPV is brief and positional; a central cause is CONSTANT, with inability to walk / truncal ataxia, vomiting, and — critically — associated neurology (dysarthria, limb clumsiness, diplopia, numbness, new headache). Here the man is high vascular risk (HTN, T2DM, ex-smoker) with preceding TIA-like episodes (jumbled speech, clumsy hand) he is minimising, and a wife whose collateral history ("not right", walked into the doorframe, face looked off) is the real red flag. The action is emergency 999/hyperacute stroke pathway (NICE NG128) — NOT prochlorperazine and reassurance, the very error that kills — and NOT aspirin at home: while stroke symptoms are ongoing, aspirin waits until brain imaging has excluded haemorrhage (the immediate aspirin 300 mg rule in NICE NG128 is for a suspected TIA whose symptoms have resolved). The hidden agenda is his fear of hospital and a buried suspicion the episodes were mini-strokes; overcome the minimising by heeding the collateral history, naming the concern honestly, enlisting his wife, and using his own buried fear to motivate acceptance of emergency care.