Differential Diagnosis for Dizziness, Diplopia, and Nystagmus
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, often accompanied by nystagmus. It's a common cause of dizziness and can lead to diplopia due to the vestibular-ocular reflex being affected.
Other Likely Diagnoses
- Vestibular Migraine: A condition that can cause vertigo, dizziness, and nystagmus, often accompanied by headache and sensitivity to light and sound. Diplopia can occur due to the migraine's effect on the brainstem and cranial nerves.
- Labyrinthitis: Inflammation of the inner ear's labyrinth, which can cause severe vertigo, dizziness, hearing loss, and nystagmus. Diplopia may result from the disruption of the vestibular-ocular reflex.
- Multiple Sclerosis: An autoimmune disease that can affect the brainstem and cranial nerves, leading to dizziness, diplopia, and nystagmus. Optic neuritis, a common presentation of MS, can also cause visual disturbances.
Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): A stroke or TIA in the brainstem or cerebellum can cause sudden onset of dizziness, diplopia, and nystagmus. Prompt recognition and treatment are crucial to prevent permanent damage or death.
- Vertebrobasilar Insufficiency: Reduced blood flow in the vertebrobasilar arteries can lead to brainstem and cerebellar dysfunction, causing dizziness, diplopia, and nystagmus. This condition requires urgent medical attention to prevent stroke.
- Wernicke's Encephalopathy: A life-threatening condition caused by thiamine deficiency, often seen in alcoholics. It can present with dizziness, diplopia, and nystagmus, among other symptoms. Prompt treatment with thiamine is essential to prevent long-term brain damage.
Rare Diagnoses
- Spinocerebellar Ataxia: A group of genetic disorders affecting the cerebellum and spinal cord, leading to progressive ataxia, dizziness, and nystagmus. Diplopia can occur due to the involvement of the brainstem and cranial nerves.
- Acoustic Neuroma: A rare benign tumor of the vestibulocochlear nerve, which can cause dizziness, hearing loss, and nystagmus. Diplopia may result from the tumor's compression of adjacent cranial nerves.
- Chiari Malformation: A congenital condition where the cerebellum protrudes into the spinal canal, potentially causing dizziness, diplopia, and nystagmus due to brainstem and cranial nerve compression.