A 76-year-old woman with a history of hypothyroidism and COPD presented with a 2-day history of nausea, vomiting, and vertigo. A clinical diagnosis of viral labyrinthitis was made, and the patient was discharged from the hospital to home with a prescription for meclizine. When her symptoms persisted 3 days later, she returned to the ED. Emesis was nonbilious and not bloody. She had not experienced diarrhea, melena, or dysuria. There was a positive 30-lb weight loss accompanied by anorexia. The patient denied fever or hearing loss but did admit to headache, slurred speech, and gait instability. She had no history of such episodes and denied recent or distant head trauma. The family history was noncontributory. She lived alone, was not receiving any medications, and did not consume alcohol, but she did have a 40-pack-year smoking history.