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Patient (male, 45) presents to the ER during an episode of vertigo. Since arriving to the ER, his episode has lasted 2 hours. On PE you observe horizontal/rotary nystagmus. He also reports nausea and vomits multiple times. He has a difficult time understanding what you're saying and asks you to "speak up" but at times he is able to hear you just fine. What do you suspect is causing his vertigo attack?

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