Differential Diagnosis for 49 F with Vertigo and Dizziness
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is a common cause of vertigo, especially in adults. It is characterized by brief, episodic vertigo triggered by specific head movements. The symptoms described, such as vertigo and dizziness severe enough to prevent driving, could be consistent with BPPV, especially if the vertigo is triggered by positional changes.
Other Likely Diagnoses
- Vestibular Migraine: A condition that can cause vertigo, dizziness, and imbalance, often accompanied by migraine headaches. Given the patient's age and symptoms, this could be a plausible diagnosis, especially if there's a history of migraines.
- Meniere's Disease: An inner ear disorder that involves vertigo, tinnitus, hearing loss, and ear fullness. While it's less common than BPPV, the combination of vertigo with other symptoms like tinnitus or hearing loss could point towards Meniere's.
- Labyrinthitis: An inner ear infection that can cause vertigo, dizziness, and hearing loss. Recent viral infections or upper respiratory symptoms could support this diagnosis.
Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): Although less common, vertigo can be a symptom of a stroke or TIA, especially if accompanied by other neurological deficits such as weakness, numbness, or difficulty with speech. Missing this diagnosis could be catastrophic.
- Multiple Sclerosis: An autoimmune disease that can cause a wide range of neurological symptoms, including vertigo and dizziness. Other symptoms such as optic neuritis, weakness, or numbness might support this diagnosis.
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus. While rare, it's a critical diagnosis not to miss due to its potential impact on hearing and neurological function.
Rare Diagnoses
- Mal de Debarquement Syndrome: A rare condition characterized by a persistent feeling of swaying or imbalance after a voyage. It's less likely but could be considered if the patient has recently traveled by sea or air.
- Superior Canal Dehiscence: A rare condition of the inner ear where there's an abnormal opening in the bone overlying the superior canal, leading to vertigo and hearing symptoms. It's a rare cause of vertigo but should be considered in patients with sound- or pressure-induced vertigo.