Differential Diagnosis for Central Vertigo

The differential diagnosis for central vertigo is broad and includes various conditions affecting the central nervous system. Here's a categorized list of potential diagnoses:

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV) of Central Origin: Although BPPV is more commonly associated with peripheral vertigo, central causes can mimic its presentation. However, the single most likely diagnosis for central vertigo is often considered to be Vestibular Migraine, given its relatively high prevalence and the fact that it can present with vertigo as a primary symptom without the necessity of headache.

• Other Likely Diagnoses

  • Multiple Sclerosis (MS): MS can cause vertigo due to lesions in the central nervous system affecting vestibular pathways.
  • Vestibular Migraine: As mentioned, a common cause of central vertigo, often presenting with or without headache.
  • Cervicogenic Vertigo: Although more controversial, it is considered by some to be of central origin due to its association with cervical spine issues affecting the central vestibular pathways.

• Do Not Miss Diagnoses

  • Posterior Circulation Stroke: A critical diagnosis to consider, as timely intervention can significantly impact outcomes. Vertigo can be a presenting symptom of a stroke in the posterior circulation.
  • Brainstem or Cerebellar Hemorrhage: Similar to stroke, hemorrhage in these areas can present with vertigo and is a medical emergency.
  • Multiple System Atrophy (MSA): A neurodegenerative disorder that can cause vertigo among other symptoms, due to its effect on the central nervous system.

• Rare Diagnoses

  • Chiari Malformation: A structural defect in the cerebellum that can cause vertigo due to compression of the brainstem and cerebellum.
  • Epidermoid Cyst: A rare, benign tumor that can compress the brainstem or cerebellum, leading to vertigo.
  • Lateral Medullary Syndrome (Wallenberg's Syndrome): A stroke syndrome affecting the lateral part of the medulla oblongata, which can present with vertigo among other symptoms.

Each of these diagnoses has a unique set of accompanying symptoms and diagnostic criteria. A thorough clinical evaluation, including history, physical examination, and appropriate imaging studies, is essential for making an accurate diagnosis.