Differential Diagnosis for Stroke Dizziness vs. Vertigo

When differentiating between stroke dizziness and vertigo, it's crucial to consider various diagnoses due to the potential severity of stroke and the need for immediate intervention. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements. It's a common cause of vertigo and can be differentiated from stroke dizziness by its episodic nature and relation to positional changes.
• Other Likely Diagnoses
  • Vestibular Migraine: This condition can cause vertigo, dizziness, and headache. It's more common in individuals with a history of migraines and can be differentiated by the presence of headache and other migraine symptoms.
  • Labyrinthitis: An inner ear infection that can cause vertigo, dizziness, and hearing loss. It's differentiated by the presence of ear symptoms and sometimes fever.
  • Meniere's Disease: A disorder of the inner ear that causes vertigo, tinnitus, hearing loss, and ear fullness. It's characterized by episodic vertigo lasting from minutes to hours.
• Do Not Miss Diagnoses
  • Posterior Circulation Stroke (including cerebellar stroke and lateral medullary syndrome): Stroke can present with dizziness or vertigo, especially if it involves the posterior circulation. It's critical to identify stroke promptly due to the time-sensitive nature of treatment.
  • Transient Ischemic Attack (TIA): Often a precursor to a full-blown stroke, TIAs can present with transient episodes of dizziness or vertigo among other symptoms.
• Rare Diagnoses
  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus. It's rare but important to consider in cases of persistent, unexplained vertigo.
  • Multiple Sclerosis: An autoimmune disease that can affect the brain and spinal cord, sometimes presenting with vertigo among other neurological symptoms. It's less common as a cause of isolated vertigo but should be considered in the appropriate clinical context.

Each diagnosis has distinct features that can help in differentiation, such as the nature and duration of symptoms, associated signs, and specific triggers. A thorough history and physical examination, along with appropriate diagnostic tests, are essential for accurate diagnosis and management.