Differential Diagnosis for the 43-year-old man with dizziness, nausea, and emesis
- Single most likely diagnosis:
- Benign Paroxysmal Positional Vertigo (BPPV): The patient's symptoms of dizziness triggered by movement of the head, particularly when rolling to the right side, and the improvement when remaining still and keeping eyes closed, are classic for BPPV. This condition is characterized by brief but intense episodes of vertigo triggered by specific head movements, often accompanied by nausea and vomiting.
- Other Likely diagnoses:
- Labyrinthitis: This is an inner ear disorder characterized by inflammation of the labyrinth, which can cause vertigo, hearing loss, and tinnitus. The patient's symptoms of dizziness and nausea could be consistent with labyrinthitis, although the lack of mention of hearing loss or tinnitus makes it less likely.
- Vestibular Neuritis: This condition involves inflammation of the vestibular nerve and can cause sudden onset of vertigo, often accompanied by nausea and vomiting. The symptoms can be triggered by head movements, similar to what the patient describes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Posterior Circulation Stroke: Although less likely given the patient's age and lack of other neurological deficits, a posterior circulation stroke (such as a cerebellar or brainstem stroke) can present with sudden onset of vertigo, nausea, and vomiting. It is crucial to consider this diagnosis due to its potential for severe consequences if missed.
- Meniere's Disease: While the episodic nature of the patient's symptoms could suggest Meniere's disease, the lack of hearing loss, tinnitus, or aural fullness makes this less likely. However, it's a condition that should be considered due to its impact on the patient's quality of life.
- Rare diagnoses:
- Acoustic Neuroma: A rare tumor on the vestibular nerve that can cause vertigo, hearing loss, and tinnitus. Given the patient's symptoms are primarily vertigo without mention of hearing loss or tinnitus, this is less likely but remains a consideration in the differential diagnosis.
- Multiple Sclerosis: Although rare, multiple sclerosis can present with vertigo among other neurological symptoms. The patient's age and lack of other neurological symptoms make this less likely, but it should be considered in a comprehensive differential diagnosis.