Differential Diagnosis for Suspected Vertigo in the Emergency Department
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of vertigo, accounting for approximately 50% of cases. It is characterized by brief, episodic vertigo triggered by specific head movements, with a benign course and high response rate to canalith repositioning procedures.
Other Likely Diagnoses
- Vestibular Neuritis: An inner ear disorder that causes inflammation of the vestibular nerve, leading to severe vertigo, often accompanied by nausea and vomiting, but without hearing loss. It is the second most common cause of vertigo.
- Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and ear fullness. The diagnosis is often made based on clinical presentation and history.
- Labyrinthitis: Inflammation of the inner ear, which can cause vertigo, hearing loss, and tinnitus. It can be viral or bacterial in origin.
Do Not Miss Diagnoses
- Posterior Circulation Stroke: Although less common, a stroke in the posterior circulation can present with vertigo, making it a critical diagnosis not to miss due to its severe implications and the need for urgent intervention.
- Multiple Sclerosis: In rare cases, vertigo can be a presenting symptom of multiple sclerosis, especially if accompanied by other neurological signs.
- Acoustic Neuroma: A benign tumor on the vestibular nerve that can cause vertigo, hearing loss, and tinnitus. Early diagnosis is crucial for effective management.
Rare Diagnoses
- Vestibular Migraine: A condition where vertigo is a migraine symptom, often accompanied by headache, but can occur without headache. It's less common than other forms of migraine but should be considered in patients with a migraine history.
- Superior Semicircular Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior semicircular canal, leading to vertigo and hearing symptoms in response to sound or pressure changes.
- Perilymphatic Fistula: An abnormal connection between the inner and middle ear, causing vertigo, hearing loss, and other symptoms, often after trauma, surgery, or barotrauma.