Differential Diagnosis for 70 yo with Dizziness and Generalized Weakness

• Single most likely diagnosis:
  • Orthostatic Hypotension: The patient's symptoms of dizziness and generalized weakness that occur when sitting or standing but resolve when lying down are classic for orthostatic hypotension. The fact that the symptoms began suddenly and have been persistent until the morning, when presumably the patient was lying down, further supports this diagnosis.
• Other Likely diagnoses:
  • Benign Paroxysmal Positional Vertigo (BPPV): Although the patient denies a spinning sensation, BPPV can sometimes present with non-specific dizziness. The triggers for BPPV, such as positional changes, could fit the patient's symptoms, especially given her history of a similar episode after a medication change.
  • Vestibular Migraine: The patient's history of tinnitus and the description of her head "swimming" could suggest a vestibular migraine, especially if the tinnitus is considered an aura. However, the lack of headache or other typical migraine symptoms makes this less likely.
• Do Not Miss diagnoses:
  • Stroke or Transient Ischemic Attack (TIA): Although the MRI and CTA are negative, it's crucial to consider stroke or TIA in any patient presenting with sudden onset of neurological symptoms, including dizziness and weakness. The absence of focal neurological deficits and negative imaging does not completely rule out these conditions, especially if the symptoms were very transient.
  • Cardiac Causes (e.g., Arrhythmias, Cardiac Ischemia): Dizziness and generalized weakness can be symptoms of cardiac issues, including arrhythmias or cardiac ischemia. These conditions require immediate attention and could be life-threatening if missed.
• Rare diagnoses:
  • Meniere's Disease: Given the patient's tinnitus and episodes of dizziness, Meniere's disease could be considered, although it typically presents with a combination of vertigo, hearing loss, tinnitus, and ear fullness. The patient's symptoms do not fully align with Meniere's, but it remains a possibility.
  • Autonomic Dysfunction: Conditions affecting the autonomic nervous system, such as autonomic failure, could lead to orthostatic hypotension and other symptoms the patient is experiencing. However, these conditions are less common and would typically be considered after more common causes have been ruled out.