Differential Diagnosis for Vertigo in the ED
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of vertigo, accounting for approximately 20-30% of cases. It is characterized by brief, episodic vertigo triggered by specific head movements, with a benign course and high response rate to canalith repositioning procedures.
Other Likely Diagnoses
- Vestibular Neuritis/Labyrinthitis: Inflammation of the vestibular nerve or inner ear, often presenting with sudden onset of vertigo, nausea, and vomiting, and sometimes hearing loss. It is usually viral in nature and can be treated with vestibular suppressants and supportive care.
- Meniere's Disease: A disorder of the inner ear that affects balance and hearing, characterized by episodes of vertigo, tinnitus, hearing loss, and ear fullness. Management includes dietary modifications, vestibular suppressants, and sometimes surgery.
- Migraine-Associated Vertigo: Vertigo can be a symptom of migraine headaches, which may or may not be accompanied by headache pain. Treatment involves managing the migraine.
Do Not Miss Diagnoses
- Posterior Circulation Stroke: Although less common, vertigo can be a presenting symptom of a stroke, particularly if it involves the posterior circulation. It is crucial to identify and treat promptly to prevent further brain injury.
- Multiple Sclerosis: In rare cases, vertigo can be an initial symptom of multiple sclerosis, an autoimmune disease affecting the central nervous system. Early diagnosis is key for appropriate management.
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus. Early detection is important for treatment planning.
Rare Diagnoses
- Superior Semicircular Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior semicircular canal, leading to vertigo and hearing symptoms in response to sound or pressure changes.
- Perilymphatic Fistula: An abnormal connection between the inner and middle ear, causing vertigo, hearing loss, and sometimes other symptoms, often after trauma or surgery.
- Vestibular Paroxysmia: A rare disorder characterized by brief, frequent episodes of vertigo, thought to be due to compression of the vestibular nerve.