Differential Diagnosis for a 60-year-old Female with Dizziness
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is a common cause of dizziness in older adults, especially women. It is characterized by brief, episodic vertigo triggered by specific head movements.
Other Likely Diagnoses
- Vestibular Migraine: Although more common in younger populations, vestibular migraines can occur in older adults and cause dizziness without the typical headache.
- Orthostatic Hypotension: This condition, often related to dehydration, medication side effects, or autonomic dysfunction, can lead to dizziness upon standing.
- Meniere's Disease: An inner ear disorder that can cause vertigo, tinnitus, hearing loss, and ear fullness, though it's less common than BPPV.
- Age-related Vestibular Decline: As people age, the vestibular system can deteriorate, leading to balance problems and dizziness.
Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): Although less common, dizziness can be a presenting symptom of a stroke or TIA, especially if accompanied by other neurological deficits.
- Cardiac Arrhythmias: Conditions like atrial fibrillation can cause dizziness due to reduced cardiac output.
- Severe Anemia or Hypoglycemia: Both conditions can lead to dizziness due to inadequate oxygen delivery or glucose supply to the brain.
- Medication Side Effects: Certain medications, such as sedatives, antihistamines, and some antidepressants, can cause dizziness as a side effect.
Rare Diagnoses
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus.
- Multiple Sclerosis: An autoimmune disease that can affect the brain and spinal cord, leading to a wide range of symptoms, including dizziness.
- Vestibular Schwannoma: Similar to acoustic neuroma but specifically refers to a tumor on the vestibular nerve.
- Mal de Debarquement Syndrome: A rare condition characterized by persistent dizziness and imbalance after a voyage, which can last for months.