Differential Diagnosis for 49yo Female with Dizziness and Nausea
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, which could explain the worsening of dizziness with eyes open due to visual-vestibular mismatch. It's a common cause of vertigo in adults and can be associated with nausea.
Other Likely Diagnoses
- Vestibular Migraine: A condition that can cause vertigo, nausea, and dizziness without the headache phase. The worsening of symptoms with visual stimuli (eyes open) could be consistent with this diagnosis.
- Labyrinthitis: An inner ear disorder that can cause dizziness, nausea, and vertigo due to inflammation of the labyrinth. The absence of hearing loss does not rule out this condition.
- Medication-induced Dizziness: Various medications can cause dizziness as a side effect. Given the patient's age and potential for polypharmacy, this is a plausible consideration.
Do Not Miss Diagnoses
- Posterior Circulation Stroke: Although less common, a stroke in the posterior circulation can present with vertigo, nausea, and dizziness without typical stroke symptoms like hemiparesis. This is a critical diagnosis not to miss due to its severe implications.
- Multiple Sclerosis: An episode of vertigo could be a presenting symptom of multiple sclerosis, especially if associated with other neurological symptoms. Early diagnosis is crucial for management.
- Cardiac Causes (e.g., Arrhythmias): Certain cardiac conditions can lead to decreased cerebral perfusion, resulting in dizziness and nausea. These conditions are critical to identify due to their potential for severe outcomes.
Rare Diagnoses
- Meniere's Disease: Characterized by episodes of vertigo, hearing loss, tinnitus, and ear fullness. While it's a possibility, the absence of hearing symptoms makes it less likely.
- Acoustic Neuroma: A benign tumor on the vestibulocochlear nerve that can cause vertigo, hearing loss, and tinnitus. It's rare and typically presents with unilateral hearing loss and tinnitus.
- Mal de Debarquement Syndrome: A rare condition that occurs after a journey by boat, plane, or car, characterized by a persistent feeling of swaying or rocking. It's an unlikely diagnosis without a recent travel history.