Differential Diagnosis for a 21-year-old Lady with Dizziness, Headache, and Poor Balance

• Single most likely diagnosis:
  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by head movements, which aligns with the patient's symptoms of dizziness on head movements and poor balance. The positive Romberg test also supports a vestibular cause.
• Other Likely diagnoses:
  • Vestibular Neuritis/Labyrinthitis: These conditions involve inflammation of the vestibular nerve or labyrinth, leading to vertigo, balance problems, and sometimes hearing loss. The patient's symptoms of dizziness, poor balance, and vomiting could be consistent with this diagnosis.
  • Migraine-associated Vertigo: Given the patient's bilateral temporal headache, this could be a migraine variant with vertigo, which is a known but less common symptom of migraines.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Posterior Circulation Stroke: Although less common in young individuals, a stroke in the posterior circulation can present with vertigo, headache, and balance problems. The normal CT head does not entirely rule out a stroke, especially if it's an early or small infarct.
  • Central Vertigo due to other causes (e.g., Multiple Sclerosis, Chiari Malformation): These conditions can present with vertigo, balance issues, and headache. A normal CT head might not capture these diagnoses, necessitating further imaging like an MRI.
• Rare diagnoses:
  • Meniere's Disease: Characterized by episodic vertigo, hearing loss, tinnitus, and ear fullness. While possible, the lack of hearing symptoms makes this less likely.
  • Acoustic Neuroma: A benign tumor on the vestibulocochlear nerve that can cause vertigo, balance problems, and hearing loss. This would be unusual in a 21-year-old without other symptoms like hearing loss or tinnitus.