Authors’ reply to Foley

[...]the presence of unidirectional nystagmus, a positive head impulse test, and imbalance are highly suggestive of vestibular neuritis. In patients with vertigo, severe imbalance, and vomiting, but no nystagmus, stroke should be considered and ruled out first. 2 Importantly, acute hearing loss may herald impending infarction in the anterior inferior cerebellar artery territory in patients with vertigo, even when no other central signs are present. 3 We are not aware of any reports of carotid or vertebral dissection as a result of a head impulse test or that an established dissection is worsened by this test.