Differential Diagnosis for Lightheadedness and SOB with Head Movement
- Single most likely diagnosis:
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, which could explain the patient's symptoms when moving from sitting to standing and walking. The fullness in one ear could be related to inner ear issues, which are common in BPPV.
- Other Likely diagnoses:
- Orthostatic Hypotension: This condition involves a significant drop in blood pressure when standing up, leading to lightheadedness and shortness of breath (SOB), which matches the patient's symptoms when transitioning from sitting to standing.
- Meniere's Disease: Although less common, this inner ear disorder can cause vertigo, fullness in the ear, and potentially lead to lightheadedness and SOB due to the associated vertigo and possible drops in blood pressure.
- Do Not Miss diagnoses:
- Cardiac Arrhythmias: Certain arrhythmias can cause lightheadedness and SOB, especially with positional changes. Missing a cardiac cause could be fatal.
- Stroke or Transient Ischemic Attack (TIA): Although less likely, vertigo and lightheadedness can be symptoms of a stroke or TIA, especially if accompanied by other neurological deficits. These conditions require immediate medical attention.
- Vestibular Migraine: While not typically fatal, vestibular migraines can cause severe vertigo and other symptoms similar to the patient's, and missing this diagnosis could lead to inappropriate treatment and significant morbidity.
- Rare diagnoses:
- Acoustic Neuroma: A rare tumor on the nerve connecting the inner ear to the brain, which could cause fullness in the ear and balance issues, potentially leading to lightheadedness.
- Superior Canal Dehiscence: A rare condition involving an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and hearing symptoms with head movement.