History of Present Illness (HPI)
The patient reports experiencing three episodes of vertigo triggered by head movements, with each episode lasting approximately 5 minutes before completely resolving. He denies any associated visual disturbances. These vertigo symptoms are new and concerning to the patient, occurring against the background of his other chronic conditions, including a cholesteatoma in the right ear that requires surgery. The patient is established with ENT and has a follow-up scheduled after a temporal bone CT.
Differential Diagnosis
- Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, which matches the patient's symptoms. The presence of a cholesteatoma and the need for surgery may indicate a possible inner ear issue, but BPPV is a common cause of vertigo and can be related to or exacerbated by other ear conditions.
- Other Likely Diagnoses
- Labyrinthitis: Given the patient's history of cholesteatoma, an inner ear infection like labyrinthitis could cause vertigo. However, labyrinthitis typically presents with hearing loss and tinnitus, which are not mentioned.
- Vestibular Migraine: Although the patient denies visual disturbances, vestibular migraines can cause vertigo without headache or visual aura. The episodic nature of the vertigo could fit this diagnosis.
- Do Not Miss Diagnoses
- Posterior Circulation Stroke or Transient Ischemic Attack (TIA): While less likely given the brief, episodic nature of the vertigo and the lack of other neurological symptoms, a stroke or TIA in the posterior circulation can cause vertigo and is a medical emergency.
- Central Cause of Vertigo (e.g., Brainstem or Cerebellar Lesion): Any central cause of vertigo, such as a tumor, stroke, or multiple sclerosis, would be critical to identify. The absence of other neurological symptoms makes this less likely but not impossible.
- Rare Diagnoses
- Meniere's Disease: Characterized by episodic vertigo, hearing loss, tinnitus, and ear fullness. The patient's symptoms do not fully align with Meniere's, as there's no mention of hearing loss or tinnitus during the episodes.
- Superior Canal Dehiscence Syndrome: A rare condition that can cause vertigo triggered by sound or pressure changes, which might not perfectly match the patient's head movement-triggered vertigo but could be considered in a differential diagnosis for vertigo.