Differential Diagnosis for Vertigo and Dizziness
When differentiating between vertigo and dizziness based on history alone, it's crucial to consider various diagnoses due to the broad range of potential causes. Here's a structured approach:
- Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements. It's a common cause of vertigo and can often be diagnosed based on history and physical examination, particularly with the Dix-Hallpike maneuver.
- Other Likely Diagnoses
- Vestibular Migraine: Patients often report vertigo, headache, and sensitivity to light or sound. The history may reveal a pattern of migraine headaches and vertigo episodes.
- Labyrinthitis: Inflammation of the inner ear can cause vertigo, hearing loss, and tinnitus. The history might include recent viral illness or upper respiratory infection symptoms.
- Meniere's Disease: Characterized by episodic vertigo, tinnitus, hearing loss, and ear fullness. The diagnosis is often based on a combination of these symptoms and their pattern over time.
- Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): Although less common, vertigo can be a presenting symptom of a posterior circulation stroke. It's critical to identify this condition promptly due to its severe implications. Risk factors and sudden onset of symptoms are key historical points.
- Multiple Sclerosis: While rare, vertigo can be an initial symptom. A history of other neurological symptoms or optic neuritis might suggest this diagnosis.
- Rare Diagnoses
- Acoustic Neuroma: A benign tumor on the vestibulocochlear nerve can cause gradual onset of vertigo, hearing loss, and tinnitus. The history might reveal a long-standing, progressive nature of symptoms.
- Autoimmune Inner Ear Disease: This condition involves sudden hearing loss and vertigo, with a history that might include recent immune system disorders or other autoimmune diseases.
History alone can provide significant clues but may not always be sufficient for a definitive diagnosis. A thorough physical examination, including neurological and vestibular assessments, and potentially further diagnostic testing (like imaging or audiometry) may be necessary to confirm the diagnosis and differentiate between these conditions.