Differential Diagnosis for Vertigo on Awakening

Single most likely diagnosis

• Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, such as lifting and bending. The patient's history of doing lots of lifting and up and down movements increases the likelihood of this diagnosis, as these activities can precipitate or exacerbate BPPV.

Other Likely diagnoses

• Cervicogenic Vertigo: This condition is caused by cervical spine dysfunction, which can be exacerbated by lifting and bending. The vertigo is typically triggered by specific neck movements.
• Labyrinthine Concussion: Although less common, a labyrinthine concussion can occur due to head trauma, which might not be immediately apparent. The history of lifting and bending could potentially contribute to a minor head injury or strain that affects the inner ear.
• Vestibular Migraine: Some patients with migraines experience vertigo as part of their migraine syndrome. The vertigo can be triggered by various factors, including physical activity.

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

• Posterior Circulation Stroke: Although less likely, a stroke affecting the posterior circulation (including the vertebrobasilar system) can present with vertigo. Given the potential for severe and permanent neurological damage, it is crucial to consider and rule out this diagnosis promptly.
• Vertebral Artery Dissection: This is a rare but potentially life-threatening condition that can cause vertigo among other symptoms. It is often associated with neck trauma or certain neck movements.

Rare diagnoses

• Meniere's Disease: An inner ear disorder that involves vertigo, but it typically presents with a combination of vertigo, hearing loss, tinnitus, and ear fullness. The episodic nature and triggers might not perfectly align with the patient's symptoms of vertigo on awakening after lifting and bending.
• Ototoxicity: Certain medications or substances can cause damage to the inner ear, leading to vertigo. However, this would typically be associated with exposure to known ototoxic agents and possibly other symptoms like hearing loss.
• Multiple Sclerosis: A demyelinating disease that can present with vertigo among a wide range of neurological symptoms. The diagnosis would require further investigation into other neurological deficits and diagnostic tests like MRI.