Differential Diagnosis for Acute Vertigo

The differential diagnosis for acute vertigo can be categorized into several groups based on the likelihood and potential impact of missing the diagnosis.

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of vertigo and is characterized by brief, episodic vertigo triggered by specific head movements. It is often related to the movement of otolith crystals in the inner ear.

• Other Likely Diagnoses

  • Vestibular Neuritis (Labyrinthitis): An inner ear disorder that causes inflammation of the vestibular nerve, leading to severe vertigo, often accompanied by nausea and vomiting, but typically without hearing loss.
  • Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and ear fullness.
  • Acute Vestibular Syndrome: A condition presenting with sudden onset of vertigo, nausea, vomiting, and imbalance, which can be due to various causes including vestibular neuritis or stroke.

• Do Not Miss Diagnoses

  • Posterior Circulation Stroke (including Cerebellar and Brainstem Stroke): Although less common than other causes of vertigo, stroke is a medical emergency that requires immediate attention. Symptoms can include sudden onset of vertigo, along with other neurological deficits such as dysarthria, diplopia, or ataxia.
  • Multiple Sclerosis: An autoimmune disease that can present with vertigo among other neurological symptoms due to demyelination in the central nervous system.
  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus.

• Rare Diagnoses

  • Migrainous Vertigo: Vertigo associated with migraine headaches, which can be episodic and may or may not be accompanied by headache.
  • 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 condition in which there is abnormal bone growth in the middle ear, which can cause vertigo, hearing loss, and balance problems.
  • Perilymphatic Fistula: An abnormal connection between the inner and middle ear, leading to vertigo, hearing loss, and sometimes tinnitus, often after trauma or surgery.