Differential Diagnosis for Persistent Dizziness

The differential diagnosis for persistent dizziness can be extensive, given the wide range of potential causes. It's crucial to approach this symptom systematically to ensure that no critical diagnoses are overlooked. Below is a categorized list of potential diagnoses:

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This is often considered the most common cause of vertigo, which is a type of dizziness. It's characterized by brief, intense episodes of vertigo triggered by specific head movements. The high prevalence and the characteristic presentation make it a leading consideration.

• Other Likely Diagnoses

  • Vestibular Migraine: A common cause of dizziness that can present with or without headache. It's more likely in individuals with a history of migraines.
  • Meniere's Disease: An inner ear disorder that involves vertigo, tinnitus, hearing loss, and ear fullness. The episodic nature of vertigo and associated auditory symptoms are key.
  • Labyrinthitis: Inflammation of the inner ear, which can cause dizziness, hearing loss, and sometimes tinnitus. Recent viral infections or exposure to individuals with infections might suggest this diagnosis.
  • Medication Side Effects: Various medications can cause dizziness as a side effect, including antihypertensives, sedatives, and antidepressants. A thorough medication history is essential.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although less common, these are critical diagnoses to consider due to their potential for severe morbidity and mortality. Sudden onset, accompanied by other neurological deficits, should raise suspicion.
  • Posterior Circulation Stroke: Specifically, vertebral or basilar artery strokes can present with isolated dizziness or vertigo, making them high on the list of "do not miss" diagnoses.
  • Cardiac Arrhythmias: Conditions like atrial fibrillation can lead to reduced cardiac output, resulting in dizziness or near-syncope.
  • Multiple Sclerosis: Although rare, an initial presentation of dizziness could be a symptom of multiple sclerosis, especially if accompanied by other neurological signs.

• Rare Diagnoses

  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause dizziness, hearing loss, and tinnitus.
  • Superior Canal Dehiscence: A rare condition where there's an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and hearing symptoms.
  • Mal de Debarquement Syndrome: A rare condition where individuals experience persistent dizziness and imbalance after a sea voyage or other motion experience.

Each of these diagnoses has distinct features and risk factors that can guide the diagnostic process. A thorough history, physical examination, and judicious use of diagnostic tests are essential for determining the underlying cause of persistent dizziness.