Differential Diagnosis for Dizziness
The differential diagnosis for dizziness is broad and can be categorized into several groups based on the likelihood and potential impact of missing the diagnosis.
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This is often the most common cause of dizziness, especially in older adults. It is characterized by brief, episodic vertigo triggered by specific head movements, with a benign course and effective treatment options available.
Other Likely Diagnoses
- Vestibular Migraine: A common cause of dizziness, especially in individuals with a history of migraines. It can present with or without headache and is often accompanied by sensitivity to light and sound.
- Labyrinthitis: An inner ear disorder that can cause dizziness, hearing loss, and tinnitus. It is usually viral in nature but can be bacterial, requiring prompt antibiotic treatment.
- Orthostatic Hypotension: Dizziness upon standing due to a drop in blood pressure. It can be caused by dehydration, medication, or autonomic dysfunction.
- Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and ear fullness.
Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): Although less common, these are critical diagnoses to consider due to their high morbidity and mortality. Dizziness can be a presenting symptom, especially in posterior circulation strokes.
- Cardiac Arrhythmias: Conditions like atrial fibrillation can cause dizziness due to reduced cardiac output. Prompt diagnosis and treatment are essential to prevent complications.
- Multiple Sclerosis: An autoimmune disease that can present with dizziness among other neurological symptoms. Early diagnosis is crucial for effective management.
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause dizziness, hearing loss, and tinnitus. Although rare, its potential impact on quality of life and the importance of early intervention make it a "do not miss" diagnosis.
Rare Diagnoses
- Mal de Debarquement Syndrome: A rare condition where individuals experience a persistent feeling of swaying or rocking after being on a boat or ship.
- Superior Canal Dehiscence: A rare condition of the inner ear where there is an abnormal opening in the bone overlying the superior canal, leading to sound- or pressure-induced vertigo.
- Chiari Malformation: A structural defect in the cerebellum that can cause dizziness, among other symptoms, due to compression of the brainstem and cerebellum.
- Autoimmune Inner Ear Disease: A rare condition where the immune system attacks the inner ear, leading to hearing loss and dizziness.