Differential Diagnosis for Dizziness

The following is a differential diagnosis for a patient presenting with dizziness, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is a common cause of dizziness, especially in older adults. It is characterized by brief, intense episodes of 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 Neuritis/Labyrinthitis: Inflammation of the inner ear can cause dizziness, often accompanied by hearing loss or tinnitus. These conditions are relatively common and should be considered in the differential diagnosis.
  • Orthostatic Hypotension: A drop in blood pressure upon standing can lead to dizziness or lightheadedness. This condition is common, especially in the elderly or those with certain medical conditions.
  • Migraine-associated Vertigo: Some patients with migraines may experience vertigo as part of their migraine syndrome. Given the prevalence of migraines, this is a plausible diagnosis for patients with a history of migraines.

• 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 devastating consequences.
  • Cardiac Arrhythmias: Certain heart rhythm disturbances can cause dizziness due to inadequate cerebral perfusion. These conditions require prompt identification and treatment.
  • Severe Hypoglycemia: Low blood sugar can cause dizziness among other symptoms, and it is crucial to recognize and treat promptly to avoid serious complications.

• Rare Diagnoses

  • Multiple Sclerosis: Although rare, multiple sclerosis can present with vertigo as an initial symptom due to central nervous system involvement.
  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain can cause dizziness, along with hearing loss and tinnitus. This condition is less common but should be considered in the differential diagnosis, especially with persistent or progressive symptoms.
  • Meniere's Disease: A disorder of the inner ear that affects balance and hearing, leading to episodes of vertigo, tinnitus, hearing loss, and ear fullness. It is less common than other causes of dizziness but important to diagnose due to its impact on quality of life.