Differential Diagnosis for Black Vision and Hearing Heartbeat in Ears

The symptoms described, "black vision and hearing heartbeat in ears," can be interpreted as experiencing transient visual disturbances (possibly fainting or near-fainting episodes) and tinnitus or pulsatile tinnitus, where one hears their heartbeat in their ears. These symptoms can be associated with various conditions, ranging from benign to life-threatening. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Anxiety or Panic Attack: This condition can cause hyperventilation, leading to transient visual disturbances and an increased awareness of one's heartbeat, potentially perceived as hearing one's heartbeat in the ears.
• Other Likely Diagnoses
  • Orthostatic Hypotension: A sudden drop in blood pressure upon standing can lead to transient visual disturbances (like black spots or near fainting) and might cause tinnitus due to decreased blood flow.
  • Hypertension: High blood pressure can lead to vascular changes that might cause pulsatile tinnitus. Visual disturbances could be related to hypertensive crises affecting the optic nerve or retina.
  • Anemia: Reduced hemoglobin or red blood cell count can lead to decreased oxygen delivery to tissues, potentially causing tinnitus, fatigue, and visual disturbances due to inadequate oxygenation.
• Do Not Miss Diagnoses
  • Cardiovascular Diseases (e.g., Aortic Stenosis, Cardiac Tamponade): Conditions that severely impair cardiac output can cause decreased blood flow to the brain and eyes, leading to visual disturbances, and might cause pulsatile tinnitus due to abnormal blood flow patterns.
  • Stroke or Transient Ischemic Attack (TIA): Although less common, sudden visual disturbances and tinnitus could be symptoms of a stroke or TIA, especially if accompanied by other neurological deficits.
  • Hypothyroidism: In rare cases, severe hypothyroidism can lead to cardiovascular and neurological symptoms, including hearing and visual disturbances.
• Rare Diagnoses
  • Multiple Sclerosis: This autoimmune disease can cause a wide range of neurological symptoms, including visual disturbances and tinnitus, though it would be less common as a primary presentation.
  • Vestibular Schwannoma (Acoustic Neuroma): A benign tumor on the nerve connecting the inner ear to the brain, which can cause tinnitus, hearing loss, and balance problems. Visual disturbances would be less common but could occur due to increased intracranial pressure.
  • Temporal Arteritis (Giant Cell Arteritis): An inflammation of the blood vessels in the head, which can cause visual disturbances, including blindness, and might lead to tinnitus due to involvement of the vessels supplying the ear.

Each of these diagnoses requires careful consideration of the patient's full clinical picture, including history, physical examination, and potentially, further diagnostic testing to determine the underlying cause of their symptoms.