Differential Diagnosis for Vertical Nystagmus
- Single most likely diagnosis
- Benign paroxysmal positional vertigo (BPPV): This condition is a common cause of vertigo and can present with vertical nystagmus, especially when the patient is in a specific head position. It is usually benign and related to the movement of otolith crystals in the inner ear.
- Other Likely diagnoses
- Vestibular migraine: This condition can cause a variety of vestibular symptoms, including vertigo and nystagmus. Vertical nystagmus can be seen, especially during acute episodes.
- Labyrinthitis: Inflammation of the inner ear can cause vertigo, hearing loss, and nystagmus, including vertical nystagmus.
- Brainstem or cerebellar stroke: Although less common, strokes in these areas can present with vertigo and nystagmus, including vertical components.
- Do Not Miss diagnoses
- Wernicke's encephalopathy: This is a serious condition caused by thiamine deficiency, often seen in alcoholics. It can present with nystagmus (including vertical), ophthalmoplegia, and ataxia. Prompt treatment is crucial to prevent long-term damage.
- Central vertigo due to multiple sclerosis or other demyelinating diseases: These conditions can cause a wide range of neurological symptoms, including vertigo and nystagmus.
- Posterior fossa tumors: Tumors in the brainstem or cerebellum can cause vertigo, nystagmus, and other neurological symptoms due to compression or invasion of critical structures.
- Rare diagnoses
- Congenital nystagmus: Although typically horizontal, some forms can have a vertical component. It's usually identified early in life.
- Perilymph fistula: An abnormal connection between the inner and middle ear can cause vertigo and nystagmus, including vertical nystagmus, often related to changes in pressure.
- Chiari malformation: A structural defect in the cerebellum that can cause a variety of symptoms, including vertigo and nystagmus, due to compression of the brainstem and cerebellum.