Differential Diagnosis
The patient's symptoms of sudden onset spinning sensation, vomiting, and jerk nystagmus with the fast component to the right after turning her head to the left suggest a vestibular disorder. Here are the possible diagnoses categorized:
- Single most likely diagnosis
- D) Peripheral vestibular system: The patient's symptoms, including the sudden onset of vertigo, vomiting, and jerk nystagmus, are consistent with a peripheral vestibular disorder, such as benign paroxysmal positional vertigo (BPPV) or labyrinthitis. The fact that the symptoms began after a mild cold and the presence of nystagmus with a latency period after head movement support this diagnosis.
- Other Likely diagnoses
- B) Left cerebellum: A cerebellar lesion, such as a stroke or tumor, could cause vertigo and nystagmus. However, the absence of other neurologic abnormalities, such as ataxia or dysarthria, makes this diagnosis less likely.
- A) Left acoustic nerve: An acoustic neuroma or other lesion affecting the left acoustic nerve could cause vertigo and nystagmus. However, this diagnosis would typically be associated with other symptoms, such as hearing loss or tinnitus.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C) Left medulla oblongata: A medullary lesion, such as a stroke or hemorrhage, could cause vertigo, nystagmus, and other neurologic symptoms. Although this diagnosis is less likely, it is critical to consider due to the potential for severe consequences if missed.
- Rare diagnoses
- E) Right cerebellum: A lesion in the right cerebellum could cause vertigo and nystagmus, but this would be an unusual presentation, and other neurologic abnormalities would be expected.
- Other rare diagnoses, such as a multiple sclerosis plaque or a brainstem lesion, could also be considered, but these would be less likely given the patient's presentation and lack of other neurologic symptoms.