Differential Diagnosis for Sensation of Falling Backward in Old Women with Neuropathy

• Single most likely diagnosis:
  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, which could be perceived as a sensation of falling. It's common in older adults and can be exacerbated by neuropathy, which may affect balance and proprioception.
• Other Likely diagnoses:
  • Vestibular Migraine: This condition can cause vertigo, including a sensation of falling, and is more common in women. Neuropathy might not be directly related but could contribute to the overall sense of instability.
  • Orthostatic Hypotension: A drop in blood pressure upon standing can cause dizziness or a feeling of falling, especially in older adults with neuropathy, which might impair the body's ability to compensate for these changes.
  • Peripheral Neuropathy itself: While primarily causing numbness, tingling, and weakness, severe peripheral neuropathy can significantly impair balance and proprioception, leading to a sensation of instability or falling.
• Do Not Miss diagnoses:
  • Posterior Circulation Stroke: Although less likely, a stroke affecting the posterior circulation can cause vertigo, imbalance, and a sensation of falling. Given the high stakes of missing a stroke, it's crucial to consider this diagnosis, especially if accompanied by other neurological deficits.
  • Cardiac Causes (e.g., Arrhythmias): Certain heart conditions can lead to reduced blood flow to the brain, resulting in dizziness or a feeling of falling. These conditions are critical to identify due to their potential for severe outcomes.
• Rare diagnoses:
  • Meniere's Disease: An inner ear disorder that can cause vertigo, but it's less common than other causes of vertigo and typically includes hearing loss and tinnitus.
  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause balance problems and vertigo, but it's rare and usually accompanied by hearing loss and tinnitus on the affected side.