Differential Diagnosis for Recurrent Falls
Single Most Likely Diagnosis
- Orthostatic Hypotension: This is a common cause of recurrent falls, especially in the elderly, due to a drop in blood pressure upon standing, leading to dizziness and loss of balance. It can be due to dehydration, medication side effects, or autonomic dysfunction.
Other Likely Diagnoses
- Vestibular Disorders: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV), labyrinthitis, or vestibular neuritis, can cause vertigo and imbalance, leading to falls.
- Musculoskeletal Issues: Weakness or instability in the muscles and bones, such as osteoporosis, osteoarthritis, or muscle dystrophy, can increase the risk of falls.
- Neurological Conditions: Parkinson's disease, stroke, or peripheral neuropathy can affect balance and coordination, leading to recurrent falls.
- Visual Impairment: Poor vision due to cataracts, glaucoma, or age-related macular degeneration can increase the risk of falls by reducing the ability to navigate safely.
Do Not Miss Diagnoses
- Cardiac Arrhythmias: Conditions like atrial fibrillation or sick sinus syndrome can cause syncope or near-syncope, leading to falls. Missing these diagnoses can be life-threatening.
- Seizure Disorders: Certain types of seizures, such as complex partial seizures, can cause falls without obvious seizure activity, making them crucial not to miss.
- Subdural Hematoma: Especially in the elderly, even minor falls can cause significant head injuries, including subdural hematomas, which require immediate medical attention.
- Infections: Sepsis or severe infections can cause confusion, weakness, and falls, particularly in vulnerable populations like the elderly or those with compromised immune systems.
Rare Diagnoses
- Multiple System Atrophy (MSA): A rare neurodegenerative disorder that can cause autonomic dysfunction, leading to orthostatic hypotension and falls.
- Ehlers-Danlos Syndrome: A genetic disorder affecting connective tissue, which can lead to joint instability and increased risk of falls.
- Mal de Debarquement Syndrome: A rare condition characterized by persistent dizziness and imbalance after a period of motion, such as a boat ride, which can increase the risk of falls.