Differential Diagnosis for a 74-year-old Female Patient with Dizziness

Single Most Likely Diagnosis

• Orthostatic Hypotension: Given the patient's age and history of type 2 diabetes mellitus (T2DM), orthostatic hypotension is a common cause of dizziness. T2DM can lead to autonomic neuropathy, which impairs the body's ability to regulate blood pressure, resulting in orthostatic hypotension.

Other Likely Diagnoses

• Vestibular Disorder: Conditions such as benign paroxysmal positional vertigo (BPPV) are common in the elderly and can cause dizziness.
• Cardiovascular Disease: The patient's age and T2DM increase her risk for cardiovascular diseases, such as arrhythmias or heart failure, which can cause dizziness.
• Medication Side Effects: Many medications, especially those used to treat hypertension, diabetes, and other common conditions in the elderly, can cause dizziness as a side effect.

Do Not Miss Diagnoses

• Stroke or Transient Ischemic Attack (TIA): Although less likely, a stroke or TIA must be considered due to the patient's age and Factor V Leiden mutation, which increases her risk of thrombosis. Dizziness can be a symptom of a posterior circulation stroke.
• Hypoglycemia: As a diabetic patient, hypoglycemia is a critical condition that can cause dizziness and must not be missed.
• Pulmonary Embolism: Given the Factor V Leiden mutation, which predisposes to thrombosis, pulmonary embolism is a potentially life-threatening condition that could cause dizziness and must be considered.

Rare Diagnoses

• Multiple System Atrophy (MSA): A rare neurodegenerative disorder that can cause orthostatic hypotension and dizziness, among other symptoms.
• Vitamin B12 Deficiency: Can cause neurological symptoms including dizziness, especially in the elderly, and is more common in patients with diabetes due to metformin use.
• Cardiac Amyloidosis: A rare condition that can cause heart failure and arrhythmias, leading to dizziness, and is more common in older adults.