Differential Diagnosis for Rotatory Vertigo
- Single most likely diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of rotatory vertigo, characterized by brief but intense episodes of vertigo triggered by specific head movements. The justification for this being the single most likely diagnosis is its high prevalence among patients presenting with vertigo.
- Other Likely diagnoses
- Meniere's Disease: A disorder of the inner ear that affects balance and hearing, leading to episodes of vertigo, tinnitus, hearing loss, and ear fullness. It's a likely diagnosis due to its association with vertigo, although the pattern of symptoms can help differentiate it from BPPV.
- Vestibular Migraine: A condition that causes vertigo, often accompanied by migraine headaches, but can occur without headache. It's considered likely because migraines are common and vestibular symptoms can be prominent.
- Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, leading to vertigo, hearing loss, and sometimes tinnitus. It's a plausible diagnosis given its direct impact on the vestibular system.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Posterior Circulation Stroke: Although less common, a stroke in the posterior circulation can present with vertigo, among other symptoms like difficulty speaking or swallowing, and weakness. Missing this diagnosis could be catastrophic, making it a "do not miss" condition.
- Multiple Sclerosis: An autoimmune disease that can affect various parts of the brain and spinal cord, leading to a wide range of potential symptoms, including vertigo. Early diagnosis is crucial for management and prognosis.
- Rare diagnoses
- Acoustic Neuroma: A non-cancerous tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus. It's rare but should be considered, especially with persistent or progressive symptoms.
- Superior Canal Dehiscence: A rare condition where there's an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and hearing symptoms. Its rarity makes it less likely, but it's an important consideration in refractory cases.