Differential Diagnosis for Woke Up Out of Sleep with Room Spinning

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, such as rolling over in bed. The symptoms described, waking up with the room spinning, are classic for BPPV, especially if the vertigo is severe and lasts for seconds to minutes.

• Other Likely Diagnoses

  • Vestibular Migraine: Although typically associated with headache, vestibular migraines can cause vertigo without headache, and the vertigo can be triggered by positional changes, such as lying down or rolling over in bed.
  • Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, which can cause severe vertigo, often accompanied by hearing loss and tinnitus. The onset can be sudden and may not necessarily be related to positional changes.
  • Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and ear fullness. While the vertigo episodes in Meniere's can be severe, they are typically longer-lasting than those in BPPV.

• Do Not Miss Diagnoses

  • Posterior Circulation Stroke: Although less common, a stroke in the posterior circulation can present with sudden onset vertigo, often accompanied by other neurological symptoms such as dysarthria, diplopia, or ataxia. It is crucial to rule out a stroke, especially in older patients or those with vascular risk factors.
  • Central Vertigo due to Other Causes (e.g., Multiple Sclerosis, Brainstem Lesions): Central causes of vertigo can present with a variety of symptoms depending on the location and nature of the lesion. These conditions are less common but critical to diagnose due to their potential impact on the patient's health and the need for specific treatments.

• Rare Diagnoses

  • Perilymphatic Fistula: A condition where there is an abnormal connection (fistula) between the inner and middle ear, leading to vertigo, hearing loss, and other symptoms. It can be traumatic or spontaneous and is relatively rare.
  • Superior Canal Dehiscence Syndrome: A rare condition where there is an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and hearing symptoms that can be triggered by sound or pressure changes.