Differential Diagnosis for Syncope with Head Turning

• Single most likely diagnosis
  • Benign paroxysmal positional vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, which could lead to syncope due to the intense vertigo and subsequent loss of balance.
• Other Likely diagnoses
  • Vasovagal syncope: This is a common cause of fainting spells, often triggered by specific stimuli such as pain, stress, or certain movements, including head turning, which can lead to a sudden drop in blood pressure and heart rate.
  • Orthostatic hypotension: This condition involves a significant drop in blood pressure upon standing, which can be exacerbated by head turning, leading to reduced blood flow to the brain and resulting in syncope.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cardiac arrhythmias (e.g., atrioventricular block, sick sinus syndrome): Certain arrhythmias can be triggered or worsened by head turning, leading to syncope. Missing these diagnoses could be fatal due to the risk of sudden cardiac death.
  • Subclavian steal syndrome: This rare condition involves reversal of blood flow in the subclavian artery, which can be triggered by arm or head movements, potentially leading to syncope due to decreased cerebral blood flow.
  • Vertebrobasilar insufficiency: This condition involves decreased blood flow in the posterior circulation of the brain, which can be exacerbated by head turning, leading to syncope and potentially more severe neurological deficits.
• Rare diagnoses
  • Chiari malformation: A structural defect in the cerebellum that can cause syncope, especially with head turning or other maneuvers that increase intracranial pressure.
  • Glossopharyngeal neuralgia: A rare condition characterized by intense pain in the throat and tongue, which can be triggered by swallowing or head movements, potentially leading to syncope due to the associated pain and autonomic responses.