Differential Diagnosis for Dizziness

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

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This is often the most 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 distinctive nature of its symptoms make it a leading consideration.

• Other Likely Diagnoses

  • Vestibular Migraine: A common cause of dizziness, especially in individuals with a history of migraines. Symptoms can include vertigo, headache, and sensitivity to light and sound.
  • Labyrinthitis: An inner ear disorder that can cause dizziness, vertigo, and hearing loss. It often follows a viral infection.
  • Medication Side Effects: Various medications, including sedatives, antidepressants, and blood pressure medications, can cause dizziness as a side effect.
  • Orthostatic Hypotension: A drop in blood pressure upon standing, leading to dizziness or lightheadedness. This can be due to dehydration, blood loss, or certain medications.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although less common, these are critical diagnoses that must be considered, especially if the dizziness is accompanied by other neurological symptoms like weakness, numbness, or difficulty speaking.
  • Meniere's Disease: A disorder of the inner ear that can cause severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness in the ear.
  • Cardiac Arrhythmias: Abnormal heart rhythms can lead to reduced blood flow to the brain, causing dizziness. Conditions like atrial fibrillation or other arrhythmias need to be ruled out.
  • Multiple Sclerosis: An autoimmune disease that can affect the brain and spinal cord, leading to a wide range of symptoms, including dizziness.

• Rare Diagnoses

  • Acoustic Neuroma: A non-cancerous tumor on the nerve connecting the inner ear to the brain, which can cause dizziness, hearing loss, and ringing in the ears.
  • Chiari Malformation: A condition where brain tissue extends into the spinal canal, which can cause dizziness among other neurological symptoms.
  • Autoimmune Inner Ear Disease: A rare condition where the immune system attacks the inner ear, leading to dizziness, vertigo, and hearing loss.

Each of these diagnoses has distinct characteristics and potential consequences, emphasizing the importance of a thorough evaluation to determine the underlying cause of dizziness.