Differential Diagnosis for a 70-year-old Female with Vertigo

Single most likely diagnosis

• Benign Paroxysmal Positional Vertigo (BPPV): This condition is the most common cause of vertigo in the elderly, resulting from the movement of calcium particles in the inner ear. The patient's age and the nature of her symptoms make BPPV a highly plausible diagnosis.

Other Likely diagnoses

• Meniere's Disease: An inner ear disorder that affects balance and hearing, leading to episodes of vertigo. Although less common than BPPV, its symptoms can align with those experienced by the patient.
• Vestibular Migraine: A condition characterized by vertigo, often accompanied by headache and sensitivity to light or sound. Given the patient's age, migraines could be a contributing factor to her vertigo.
• Labyrinthitis: An inner ear infection that causes vertigo, hearing loss, and sometimes tinnitus. The patient's symptoms could be indicative of this condition, especially if there's a history of recent infection.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

• Posterior Circulation Stroke: Although less common, a stroke affecting the posterior circulation can present with vertigo as a primary symptom. Given the potential for severe and permanent damage, it's crucial to rule out this diagnosis.
• Multiple Sclerosis: An autoimmune disease that can affect the brain and spinal cord, sometimes presenting with vertigo among other neurological symptoms. Early diagnosis is key to managing the disease effectively.
• Acoustic Neuroma: A non-cancerous tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus. Due to its potential impact on the patient's quality of life, it's essential to consider this diagnosis.

Rare diagnoses

• Superior Semicircular Canal Dehiscence: A rare condition where there's an abnormal opening in the bone overlying the superior semicircular canal, leading to vertigo and hearing symptoms.
• Perilymphatic Fistula: A rare condition involving an abnormal connection between the inner and middle ear, causing vertigo, hearing loss, and other symptoms.
• Cogan Syndrome: A rare disorder characterized by recurrent corneal inflammation and vestibular-auditory symptoms, including vertigo. Its rarity and potential for serious complications make it a diagnosis not to overlook.