Differential Diagnosis for 70y Patient with Severe Dizziness and MRI C Spine

Given the symptoms of severe dizziness in a 70-year-old patient and the context of an MRI of the cervical spine, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Cervical Spondylosis: This condition is common in the elderly and can cause dizziness due to compression or irritation of the spinal cord or vertebral arteries. The MRI would likely show degenerative changes such as disc herniation, osteophytes, or spinal stenosis.
• Other Likely Diagnoses
  • Cervical Disc Herniation: Similar to cervical spondylosis, a herniated disc can compress nerves or the spinal cord, leading to dizziness among other symptoms.
  • Vertebral Artery Compression or Stenosis: Compression or stenosis of the vertebral arteries can lead to vertebral-basilar insufficiency, causing dizziness.
  • Chiari Malformation: Although more common in younger populations, a Chiari malformation can cause symptoms in the elderly, especially if there's a significant change in cerebrospinal fluid dynamics or if the malformation is acquired due to other conditions like syringomyelia.
• Do Not Miss Diagnoses
  • Spinal Cord Infarction or Ischemia: Although less common, spinal cord infarction can present with sudden onset of neurological deficits, including dizziness, and is critical to diagnose early for potential intervention.
  • Epidural or Subdural Hematoma: These conditions are emergencies that can present with sudden onset of neurological symptoms, including dizziness, and require immediate medical attention.
  • Multiple Sclerosis or Acute Disseminated Encephalomyelitis (ADEM): While less likely in a new presentation at 70, these demyelinating diseases can cause a wide range of neurological symptoms, including dizziness.
• Rare Diagnoses
  • Cervical Spine Tumors: Both primary and metastatic tumors can occur in the cervical spine and cause neurological symptoms by compressing the spinal cord or nerves.
  • Inflammatory or Infectious Processes (e.g., Abscess, Osteomyelitis): These conditions can cause destruction of the cervical spine and lead to neurological symptoms, including dizziness.
  • Syringomyelia: A condition characterized by the formation of a fluid-filled cavity or syrinx within the spinal cord, which can expand and compress the spinal cord from within, leading to a variety of neurological symptoms.

Each of these diagnoses has the potential to explain the patient's symptoms, with the likelihood varying based on the patient's age, presentation, and the specific findings on the MRI of the cervical spine.