Differential Diagnosis for Dizziness

The differential diagnosis for dizziness is broad and can be categorized based on the likelihood and potential impact of missing a diagnosis. Here's a structured approach:

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This is often the most common cause of vertigo, which is a type of dizziness characterized by the sensation of spinning. It's related to the movement of the head and is usually self-limiting but can be very distressing.

• Other Likely Diagnoses

  • Vestibular Migraine: A condition that involves vertigo, often accompanied by headache, sensitivity to light and sound, and sometimes visual auras. It's a common cause of dizziness in patients with a history of migraines.
  • Labyrinthitis: An inner ear disorder characterized by inflammation of the part of the inner ear responsible for balance (labyrinth). It can cause severe vertigo, hearing loss, and tinnitus.
  • Medication Side Effects: Many medications can cause dizziness as a side effect, including antihistamines, antidepressants, and blood pressure medications.
  • Anxiety Disorders: Conditions like panic disorder and generalized anxiety can manifest with symptoms of dizziness or lightheadedness.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although less common, dizziness can be a symptom of a stroke or TIA, especially when accompanied by other neurological deficits. Missing this diagnosis can be catastrophic.
  • Cardiac Arrhythmias: Abnormal heart rhythms can lead to reduced blood flow to the brain, causing dizziness or lightheadedness. Conditions like atrial fibrillation or ventricular tachycardia require immediate attention.
  • Hypertensive Crisis: Severely high blood pressure can lead to dizziness among other symptoms, and requires urgent treatment to prevent complications like stroke or heart attack.
  • Multiple Sclerosis: This autoimmune disease can cause a wide range of neurological symptoms, including dizziness, especially during relapses.

• Rare Diagnoses

  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus.
  • Meniere's Disease: A disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), hearing loss, and a feeling of fullness in the ear.
  • Autoimmune Inner Ear Disease: A rare condition where the body's immune system attacks the inner ear, leading to hearing loss and vertigo.

Each of these diagnoses has distinct features and requires a careful history, physical examination, and sometimes additional tests for accurate diagnosis and appropriate management.