Differential Diagnosis for Alcoholic with Dizziness

Given the scenario of an alcoholic patient complaining of dizziness, with normal labs and no acute findings on CT head, the differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Alcohol Withdrawal: This is a common condition in alcoholics that can present with dizziness among other symptoms like tremors, agitation, and hallucinations. The normal labs and lack of acute findings on CT head, in the context of a history of alcohol use, make this a plausible diagnosis.
• Other Likely Diagnoses
  • Benign Paroxysmal Positional Vertigo (BPPV): Although more common in the elderly, BPPV can occur in anyone and is characterized by brief but intense episodes of vertigo triggered by specific head movements. Alcohol use might not be directly related but could exacerbate symptoms.
  • Vestibular Neuritis: This condition, often related to viral infections, affects the inner ear and can cause severe vertigo. Alcoholics might be more susceptible to infections due to compromised immune systems.
  • Hypoglycemia: Alcoholics are at risk for hypoglycemia due to poor dietary intake and the effect of alcohol on glucose metabolism. Dizziness can be a symptom of hypoglycemia, even if labs were normal at the time of testing, as glucose levels can fluctuate.
• Do Not Miss Diagnoses
  • Wernicke's Encephalopathy: A serious condition caused by thiamine deficiency, common in alcoholics. It presents with the triad of confusion, ataxia, and ophthalmoplegia but can initially manifest with nonspecific symptoms like dizziness. Missing this diagnosis can lead to irreversible brain damage.
  • Subdural Hematoma: Although the CT head was reported as showing no acute findings, subdural hematomas can be subtle, especially if they are small or chronic. Alcoholics are at increased risk due to falls and coagulopathy.
  • Posterior Circulation Stroke: Strokes in the posterior circulation can present with vertigo, among other symptoms. The CT head might not always show early ischemic changes, making clinical suspicion crucial.
• Rare Diagnoses
  • Multiple Sclerosis: Although rare, multiple sclerosis can present with vertigo as part of its initial symptomatology. The lack of other neurological findings and normal CT head makes this less likely but not impossible.
  • Acoustic Neuroma: A benign tumor of the vestibulocochlear nerve can cause vertigo, hearing loss, and tinnitus. It's a rare condition and would not be expected to have abnormal labs or CT findings unless it has grown significantly.

Each of these diagnoses should be considered in the context of the patient's full clinical picture, including history, physical examination, and potentially further diagnostic testing.