Differential Diagnosis for Neck Pain and Vertigo

Single Most Likely Diagnosis

• Cervicogenic Vertigo: This condition is characterized by vertigo and dizziness caused by neck pain and movement. Given the patient's history of right-sided neck pain causing vertigo and the current presentation of neck pain with vertigo and positional dizziness, this diagnosis is highly plausible.

Other Likely Diagnoses

• Benign Paroxysmal Positional Vertigo (BPPV): Although the patient's symptoms are more chronic than typical for BPPV, the presence of positional dizziness and vertigo suggests this could be a contributing factor.
• Cervical Spondylosis: The patient's history of chronic neck pain and recent exacerbation could be related to cervical spondylosis, which might also contribute to vertigo symptoms through cervical spine instability or compression of vertebral arteries.
• Migraine-Associated Vertigo: The patient's complaint of headache (HA) alongside vertigo and neck pain could suggest a migraine component to her symptoms, as migraines can cause vertigo.

Do Not Miss Diagnoses

• Vertebral Artery Dissection: Although less likely, this is a critical diagnosis to consider due to its potential for severe consequences, including stroke. The patient's history of neck pain and vertigo could be indicative of vertebral artery dissection, especially if there's a history of trauma or certain underlying conditions.
• Multiple Sclerosis: Given the patient's family history of Chiari malformation and her own symptoms of vertigo and neck pain, multiple sclerosis should be considered, as it can present with a wide range of neurological symptoms.
• Cervical Spine Fracture or Instability: Especially in the context of recent onset or worsening of symptoms, it's crucial to rule out any acute injury or instability of the cervical spine, which could have serious implications if not promptly addressed.

Rare Diagnoses

• Chiari Malformation: While the patient has a family history of Chiari malformation, her symptoms do not directly suggest this diagnosis unless there are other signs of brainstem or cerebellar dysfunction not mentioned.
• Vestibular Migraine with Cervicogenic Component: This could be considered if the patient's symptoms of vertigo, headache, and neck pain are interrelated, suggesting a complex condition involving both vestibular and cervical components.

History of Present Illness (HPI)

The patient presents with a complaint of left neck pain accompanied by vertigo that has been ongoing for 2 days. She also experiences positional dizziness and headaches. Notably, she has a history of right-sided neck pain over the last year that has caused vertigo, suggesting a possible chronic condition. The patient denies any vision changes but reports that her symptoms are significant enough to warrant a neck MRI, which is scheduled. She has a family history of Chiari malformation and has recently moved to the Lubbock area, seeking continuation of care once her insurance situation is resolved. The patient's pain is reproducible on examination of the neck and is reported to cause vertigo, indicating a potential cervicogenic component to her symptoms.