Differential Diagnosis
- Single most likely diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by head movements, which matches the patient's symptoms. The fact that symptoms worsen with head movements and the patient has experienced a similar episode in the past that resolved spontaneously supports this diagnosis.
- Other Likely diagnoses
- Vestibular Migraine: Although the patient does not report headache, vestibular migraines can present with vertigo, nausea, and sensitivity to motion without headache. The sensation of pressure in the ear area could be related to migraine-related symptoms.
- Labyrinthitis: This is an inner ear disorder characterized by inflammation of the labyrinth, which could cause vertigo, nausea, and a sensation of pressure in the ear. However, the absence of hearing loss or tinnitus makes this less likely.
- 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, nausea, and imbalance. Given the potential severity of a missed stroke, it's crucial to consider this diagnosis, especially if other risk factors for stroke are present.
- Multiple Sclerosis: Episodes of vertigo can be a symptom of multiple sclerosis, especially if associated with other neurological symptoms. While not immediately life-threatening, missing a diagnosis of MS could delay appropriate treatment.
- Rare diagnoses
- Meniere's Disease: Characterized by vertigo, hearing loss, tinnitus, and ear fullness. The absence of hearing loss and tinnitus in this patient makes Meniere's less likely, but it could be considered if symptoms evolve.
- Perilymphatic Fistula: A rare condition causing vertigo, hearing loss, and tinnitus due to an abnormal connection between the inner and middle ear. The lack of hearing loss and tinnitus, along with the episodic nature of symptoms, makes this diagnosis less probable.