Differential Diagnosis for Vertigo
When approaching a patient with vertigo, it's crucial to consider a wide range of potential causes due to the diverse etiologies that can lead to this symptom. The differential diagnosis can be organized into the following categories:
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This is often the most common cause of vertigo. It is characterized by brief, episodic vertigo triggered by specific head movements, with a benign course and good response to particle repositioning maneuvers. The justification for considering BPPV as the single most likely diagnosis lies in its high prevalence among patients presenting with vertigo.
Other Likely Diagnoses
- Vestibular Migraine: A common cause of vertigo, especially in patients with a history of migraines. The vertigo can be episodic and may or may not be accompanied by headache.
- Meniere's Disease: Characterized by episodic vertigo, hearing loss, tinnitus, and ear fullness. It's a disorder of the inner ear that affects balance and hearing.
- Labyrinthitis: Inflammation of the inner ear, which can cause vertigo, hearing loss, and tinnitus. It can be viral or bacterial in origin.
- Acute Vestibular Syndrome (e.g., vestibular neuritis): Sudden onset of vertigo, often with nausea and vomiting, but without hearing loss or neurological deficits.
Do Not Miss Diagnoses
- Posterior Circulation Stroke (including cerebellar stroke and lateral medullary syndrome): Although less common, stroke is a critical diagnosis to consider due to its potential for severe morbidity and mortality. Symptoms can include sudden onset of vertigo, ataxia, dysarthria, and other neurological deficits.
- Multiple Sclerosis: Can present with vertigo among other neurological symptoms, and is important to diagnose early for appropriate management.
- Vertebral Artery Dissection: A condition where the inner layer of the vertebral artery tears, which can lead to stroke. It may present with vertigo, neck pain, and headache.
Rare Diagnoses
- Autoimmune Inner Ear Disease: A rare condition where the immune system attacks the inner ear, leading to vertigo, hearing loss, and sometimes tinnitus.
- Otosclerosis: A form of bone growth in the middle ear that can cause hearing loss and vertigo.
- Perilymphatic Fistula: An abnormal connection between the inner and middle ear, which can cause vertigo and hearing loss, often after trauma or surgery.
Each of these diagnoses has distinct features and requires a careful history, physical examination, and sometimes additional diagnostic tests to confirm the diagnosis and guide appropriate treatment.