Differential Diagnosis for Dizziness Elicited by Moving Head Up and Down

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 moving the head up and down. It is the most common cause of vertigo and is related to the movement of otolith crystals in the inner ear.

Other Likely Diagnoses

• Vestibular Migraine: Although not exclusively triggered by head movements, vestibular migraines can cause vertigo and dizziness that may be exacerbated by movement. The symptoms can be similar to BPPV but are often accompanied by other migraine symptoms.
• Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, which can cause dizziness, vertigo, and balance problems. It might be triggered or worsened by head movements.
• Meniere's Disease: A disorder of the inner ear that affects balance and hearing. While its primary symptoms include vertigo, tinnitus, hearing loss, and ear fullness, vertigo episodes can sometimes be triggered by head movements.

Do Not Miss Diagnoses

• Posterior Circulation Stroke: Although less common, a stroke in the posterior circulation can present with vertigo, among other symptoms like difficulty speaking, swallowing, or visual disturbances. It's crucial to rule out a stroke due to its severe consequences.
• Multiple Sclerosis: In rare cases, multiple sclerosis can present with vertigo as an initial symptom, especially if there's involvement of the brainstem or cerebellum. Given its potential for significant morbidity, it should not be missed.
• Vertebral Artery Dissection: A tear in the vertebral artery can lead to stroke or transient ischemic attack, presenting with vertigo among other symptoms. Early diagnosis is critical for treatment.

Rare Diagnoses

• Perilymphatic Fistula: A rare condition involving an abnormal connection (fistula) in the inner ear, leading to symptoms like vertigo, hearing loss, and tinnitus, which can be exacerbated by changes in pressure or head movements.
• 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 that can be triggered by sound or pressure changes, including possibly head movements.