Differential Diagnosis

The patient presents with symptoms of head spinning on waking, tinnitus, ear itching, and double vision, along with a history of pre-diabetes, hypertension, and a recent hospital admission for chest pain and elevated D-dimer. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Benign Paroxysmal Positional Vertigo (BPPV): The patient's complaint of head spinning on waking, which settles during the day, and the absence of other alarming symptoms such as headaches, loss of consciousness, or focal neurological deficits, makes BPPV a likely diagnosis. The brief, episodic nature of vertigo, particularly triggered by positional changes like waking up, is characteristic of BPPV.
• Other Likely Diagnoses
  • Meniere's Disease: Given the patient's symptoms of tinnitus, ear itching, and vertigo, Meniere's disease is a plausible diagnosis. However, the classic presentation includes aural fullness and hearing loss, which are not explicitly mentioned.
  • Hypertension-related Vertigo: The patient's history of hypertension could contribute to vertigo, possibly through effects on the inner ear or vestibular system, although this is less common.
  • Vestibular Migraine: Although the patient denies headaches, vestibular migraines can present with vertigo without headache, and the chronic double vision could be related to migraine phenomena.
• Do Not Miss Diagnoses
  • Stroke or Transient Ischemic Attack (TIA): Although the patient had a normal CTP and was treated for LRTI recently, and there are no clear focal neurological deficits, stroke or TIA must always be considered in the differential for vertigo, especially given the patient's history of hypertension and recent chest pain with elevated D-dimer.
  • Multiple Sclerosis: The combination of vertigo, tinnitus, and double vision could suggest a demyelinating disease like multiple sclerosis, especially if there are other neurological symptoms or signs.
  • Vestibular Schwannoma (Acoustic Neuroma): This is a less likely but critical diagnosis to consider due to the patient's tinnitus and vertigo. Early detection is crucial for effective management.
• Rare Diagnoses
  • Autoimmune Inner Ear Disease: This condition can present with vertigo, hearing loss, and tinnitus, and is associated with autoimmune disorders.
  • Superior Canal Dehiscence Syndrome: Characterized by sound-induced or pressure-induced vertigo, and possibly hearing loss or autophony, this is a rare condition that could explain some of the patient's symptoms.