Differential Diagnosis for Vertigo
The patient's symptoms of intermittent vertigo, double vision, and difficulty speaking, triggered by head movement, suggest a complex neurologic condition. The presence of a carotid bruit and the patient's history of vascular disease are significant findings.
Single most likely diagnosis
- B) Dissection of the carotid artery: The patient's symptoms of vertigo, double vision, and difficulty speaking, combined with the presence of a carotid bruit, suggest a possible dissection of the carotid artery. This condition can lead to decreased blood flow to the brain, causing neurologic symptoms. The patient's history of hypertension and atherosclerotic disease increases the risk of carotid dissection.
Other Likely diagnoses
- E) Narrowing of the vertebral artery: Vertebral artery stenosis or occlusion can cause vertebrobasilar insufficiency, leading to symptoms such as vertigo, double vision, and difficulty speaking. The patient's history of vascular disease and the absence of other clear causes make this a plausible diagnosis.
- C) Exaggerated response to neuroreceptors: This option is less specific but could refer to conditions such as benign paroxysmal positional vertigo (BPPV), which is characterized by brief episodes of vertigo triggered by head movements. However, BPPV typically does not cause double vision or difficulty speaking.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B) Dissection of the carotid artery (also listed as the single most likely diagnosis): Given its potential for severe and fatal outcomes, including stroke, it is crucial not to miss this diagnosis.
- E) Narrowing of the vertebral artery: Similar to carotid dissection, vertebral artery stenosis or occlusion can lead to severe neurologic deficits or death if not promptly addressed.
Rare diagnoses
- A) Destruction of cochlear branch of the vestibulocochlear nerve: This would more likely cause hearing loss or tinnitus rather than the patient's primary complaint of vertigo triggered by head movement.
- D) Increased endolymph pressure in the semicircular canal: This refers to Meniere's disease, which typically causes vertigo, hearing loss, tinnitus, and aural fullness. The patient's lack of hearing symptoms makes this diagnosis less likely.