Differential Diagnosis for Dizziness

The differential diagnosis for dizziness is broad and can be categorized based on the likelihood and potential impact of missing a diagnosis. Here's a structured approach:

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements. It's a common cause of dizziness and has a relatively straightforward diagnostic test (Dix-Hallpike maneuver) and treatment (canalith repositioning procedure).

• Other Likely Diagnoses

  • Vestibular Migraine: A condition that presents with vertigo, often accompanied by headache, sensitivity to light or sound, and sometimes visual auras. It's a common cause of episodic vertigo in patients with a history of migraines.
  • Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, which can cause vertigo, hearing loss, and tinnitus. It often follows a viral infection.
  • Medication-induced Dizziness: Many medications can cause dizziness as a side effect, including antihypertensives, sedatives, and antidepressants. The history of medication use is crucial in identifying this cause.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although less common, vertigo can be a presenting symptom of a stroke or TIA, especially if accompanied by other neurological deficits. Prompt recognition is critical for timely intervention.
  • Posterior Circulation Infarct: Similar to stroke, infarcts in the posterior circulation can present with vertigo, among other symptoms, and require urgent evaluation.
  • Cardiac Causes (e.g., Arrhythmias, Cardiac Valve Problems): Conditions like atrial fibrillation can lead to reduced cardiac output, causing dizziness. Identifying cardiac causes is crucial due to their potential for serious complications.

• Rare Diagnoses

  • Multiple Sclerosis: Although rare, multiple sclerosis can present with vertigo as an initial symptom due to central nervous system demyelination.
  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus.
  • Meniere's Disease: A disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or pressure in the ear. It's less common than other causes of dizziness but significant due to its impact on quality of life.

Each of these diagnoses has distinct features and requires a tailored approach to diagnosis and treatment. A thorough history, physical examination, and sometimes additional tests are necessary to determine the underlying cause of dizziness.