Differential Diagnosis for Dizziness when Looking Down or Up
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, such as looking down or up. It is the most common cause of vertigo and is related to the movement of otolith crystals in the inner ear.
Other Likely Diagnoses
- Vestibular Migraine: A condition that involves vertigo as a primary symptom, often triggered by specific movements or positions. It can be accompanied by headache, sensitivity to light and sound, and other migraine symptoms.
- Cervicogenic Dizziness: Dizziness that originates from the cervical spine, often due to neck pain or injury. Looking down or up can exacerbate the condition by putting strain on the neck.
- Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, which can cause vertigo, dizziness, and balance problems. It may be triggered or worsened by certain head movements.
Do Not Miss Diagnoses
- Posterior Circulation Stroke: Although less common, a stroke affecting the posterior circulation of the brain can cause sudden onset of vertigo, among other symptoms like difficulty speaking or swallowing. It is critical to rule out this condition due to its severe consequences.
- Multiple Sclerosis: An autoimmune disease that can affect the brain and spinal cord, leading to a wide range of symptoms, including vertigo. Early diagnosis is crucial for effective management.
- Acoustic Neuroma: A non-cancerous tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and balance problems. Early detection is important for treatment planning.
Rare Diagnoses
- Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. It is less common than BPPV but can significantly impact quality of life.
- Superior Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and hearing symptoms triggered by sound or pressure changes.
- Chiari Malformation: A structural defect in the cerebellum that controls balance, which can cause vertigo among other neurological symptoms. It is a rare condition but important to consider in the differential diagnosis of dizziness triggered by positional changes.