Differential Diagnosis
- Single most likely diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, which could be precipitated by sitting down or changing positions while eating dinner. The symptoms of spinning and nausea, followed by lightheadedness, align with BPPV, especially if the patient experienced relief when the positional trigger was removed.
- Other Likely diagnoses
- Vestibular Migraine: This condition can cause vertigo, nausea, and lightheadedness, often without the headache typically associated with migraines. The onset of symptoms while sitting could be related to changes in posture or other triggers.
- Inner Ear Infection (Labyrinthitis): An infection of the inner ear can cause vertigo, nausea, and imbalance. The symptoms could start suddenly and might be accompanied by hearing changes or ear pain.
- Orthostatic Hypotension: This condition involves a drop in blood pressure upon standing, leading to lightheadedness. However, the initial spinning and nausea suggest a more complex etiology than simple orthostatic hypotension.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- 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. It's crucial to assess for other signs such as weakness, numbness, or speech difficulties.
- Posterior Circulation Stroke: This type of stroke can present with vertigo, nausea, and vomiting, among other symptoms. Given the potential for serious outcomes, it's essential to consider this diagnosis.
- Cardiac Arrhythmias: Certain arrhythmias can cause lightheadedness or syncope. If the patient has a history of heart disease, this should be considered, especially if symptoms worsen with standing or exertion.
- Rare diagnoses
- Meniere's Disease: This inner ear disorder can cause episodes of vertigo, hearing loss, and tinnitus. While it's less likely given the acute onset, it should be considered in the differential, especially if symptoms recur or are accompanied by hearing changes.
- Multiple Sclerosis: In rare cases, multiple sclerosis can present with vertigo as an initial symptom. This would be considered if other neurological symptoms are present or if the patient has a history suggestive of demyelinating disease.
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain can cause vertigo, hearing loss, and tinnitus. This diagnosis is less likely without a history of progressive symptoms but should be considered if other signs such as unilateral hearing loss are present.