Differential Diagnosis

The patient presents with a combination of symptoms including balance issues/vertigo, neck and back pain, fatigue, and occasional double vision. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Benign Paroxysmal Positional Vertigo (BPPV): Given the patient's history of vertigo, unsteady gait, and positive Romberg test, BPPV is a strong consideration. The neck pain with audible sounds on head turning also suggests a possible cervical spine component that could be contributing to the vertigo.
• Other Likely Diagnoses
  • Cervical Spondylosis: The patient's neck pain, which improves with warm compresses, and the audible sounds on head turning, could be indicative of cervical spondylosis. The recent chiropractor X-ray suggesting degenerative disc disease in the lumbar spine also supports a musculoskeletal origin for some of the symptoms.
  • Anemia: The patient's known anemia, as indicated by low iron levels, could be contributing to the fatigue and possibly to some extent the weakness and dizziness.
  • Migraine: Given the patient's history of unilateral migraines, it's possible that some of the symptoms, including vertigo and double vision, could be migraine-related.
• Do Not Miss Diagnoses
  • Multiple Sclerosis: Although less likely, multiple sclerosis (MS) can present with a wide range of neurological symptoms, including vertigo, double vision, and weakness. The absence of other clear focal neurological deficits does not rule out MS, making it a "do not miss" diagnosis.
  • Vestibular Schwannoma (Acoustic Neuroma): This is a rare tumor on the vestibulocochlear nerve that can cause vertigo, balance problems, and hearing loss. Although the patient does not report hearing loss, the possibility of a vestibular schwannoma should be considered, especially if other diagnoses are ruled out.
  • Stroke or Transient Ischemic Attack (TIA): While the patient's symptoms have been ongoing and there's no clear indication of acute neurological deficits, it's crucial to consider the possibility of a stroke or TIA, especially given the vertigo and double vision.
• Rare Diagnoses
  • Meniere's Disease: This inner ear disorder can cause vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Although the patient does not report tinnitus or hearing loss, Meniere's could be considered if other diagnoses are excluded.
  • Chiari Malformation: A structural defect in the cerebellum that can cause a range of neurological symptoms, including vertigo, double vision, and muscle weakness. This diagnosis would typically require imaging of the brain to confirm.