Differential Diagnosis for Patient with Vertigo and Spinal Narrowing

The patient's complaints of vertigo when looking to the left, combined with the findings of neural foraminal narrowing at multiple cervical spine levels, suggest a complex interplay between mechanical and possibly neurological factors. Here's a structured approach to the differential diagnosis:

• Single Most Likely Diagnosis

  • Cervical Spondylosis with Foraminal Stenosis: This condition is characterized by the wear and tear of the cervical spine, leading to narrowing of the neural foramina. The patient's symptoms of vertigo when turning the head to the left could be due to the compression of the cervical nerve roots or vertebral arteries, which can lead to vertebrobasilar insufficiency. The presence of moderate neural foraminal narrowing at multiple levels supports this diagnosis.

• Other Likely Diagnoses

  • Cervical Disc Herniation: Herniation of the cervical discs at the levels of narrowing (C3-C4, C4-C5, C5-C6) could compress the nerve roots, leading to symptoms such as vertigo, especially if the herniation affects the nerves that contribute to the vestibular system or if it leads to cervical spine instability.
  • Degenerative Cervical Spine Disease: This encompasses a range of conditions including spondylosis, disc degeneration, and ligamentum flavum hypertrophy, all of which can contribute to neural foraminal narrowing and subsequent symptoms.

• Do Not Miss Diagnoses

  • Vertebral Artery Dissection or Stenosis: Although less common, dissection or stenosis of the vertebral artery can lead to vertebrobasilar insufficiency, presenting with vertigo among other symptoms. The mechanical stress from cervical spine abnormalities could potentially contribute to or exacerbate vertebral artery pathology.
  • Spinal Cord Compression: Severe narrowing of the spinal canal due to spondylosis, disc herniation, or other causes could lead to spinal cord compression, presenting with a range of neurological symptoms including vertigo, weakness, and sensory changes.

• Rare Diagnoses

  • Rheumatoid Arthritis or Other Inflammatory Spondyloarthropathies: These conditions can lead to cervical spine instability and narrowing, although they are less common causes of the patient's specific presentation.
  • Tumors (e.g., Schwannomas, Neurofibromas): Although rare, tumors affecting the cervical spine or nerve roots could cause neural foraminal narrowing and lead to symptoms such as vertigo.
  • Infections (e.g., Osteomyelitis, Discitis): Infections of the cervical spine are rare but can cause destruction of the vertebral bodies or discs, leading to narrowing and neurological symptoms.

Each of these diagnoses should be considered in the context of the patient's full clinical presentation, including a thorough history, physical examination, and potentially additional diagnostic tests such as MRI of the cervical spine or vascular studies.