Differential Diagnosis for Dizziness

Dizziness is a common symptom that can be caused by a variety of conditions. Here's a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This is a common cause of dizziness, especially in older adults. It is characterized by brief, episodic vertigo triggered by specific head movements. The high prevalence and the characteristic presentation make it a likely diagnosis for many patients presenting with dizziness.

• Other Likely Diagnoses

  • Vestibular Migraine: A condition that involves vertigo, often accompanied by headache, sensitivity to light and sound, and sometimes visual auras. Its relatively high prevalence among patients with dizziness and its association with migraine headaches make it a plausible diagnosis.
  • Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, which can cause dizziness, hearing loss, and tinnitus. The combination of vertigo with auditory symptoms suggests this diagnosis.
  • Orthostatic Hypotension: A condition where blood pressure drops when standing up, leading to dizziness or lightheadedness. This is common, especially in the elderly or those with dehydration or certain medications.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although less common than other causes of dizziness, stroke or TIA can present with vertigo and are medical emergencies. Missing these diagnoses can have severe consequences, including death or permanent disability.
  • Cardiac Arrhythmias: Certain heart rhythm disturbances can cause dizziness due to inadequate cerebral blood flow. These conditions require prompt diagnosis and treatment to prevent serious outcomes.
  • Multiple Sclerosis: An autoimmune disease that can affect the brain and spinal cord, sometimes presenting with vertigo among other neurological symptoms. Early diagnosis is crucial for management and prognosis.

• Rare Diagnoses

  • Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and ear fullness. It's less common than other causes of dizziness but should be considered in patients with a combination of auditory and vestibular symptoms.
  • Acoustic Neuroma: A non-cancerous tumor on the nerve connecting the inner ear to the brain, which can cause dizziness, hearing loss, and tinnitus. It's rare but important to diagnose due to its potential impact on hearing and neurological function.
  • Mal de Debarquement Syndrome: A rare condition characterized by a persistent feeling of swaying or imbalance after a voyage. It's an uncommon cause of dizziness but should be considered in individuals with a history of recent travel by sea or air.