Vertigo Differential Diagnosis
The following is a differential diagnosis for vertigo, categorized for clarity and emphasis on critical conditions.
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of vertigo. It is characterized by brief, episodic vertigo triggered by specific head movements, with a benign course and good response to treatment such as the Epley maneuver. The high prevalence and characteristic presentation make it the single most likely diagnosis for many patients presenting with vertigo.
Other Likely Diagnoses
- Vestibular Migraine: A common cause of vertigo, especially in patients with a history of migraines. It can present with or without headache and may include sensitivity to light and sound.
- Labyrinthitis: An inner ear disorder characterized by inflammation of the labyrinth, which can cause vertigo, hearing loss, and tinnitus. It often follows a viral infection.
- Meniere's Disease: A disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), hearing loss, and a feeling of fullness in the ear. The episodes can be severe and debilitating.
Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): Although less common than other causes of vertigo, stroke or TIA can present with vertigo and must be ruled out promptly due to the high risk of permanent neurological damage or death. The presence of other neurological deficits or risk factors for stroke increases the urgency of this diagnosis.
- Posterior Circulation Stroke: Specifically, vertebrobasilar insufficiency can cause vertigo and is a medical emergency. Symptoms may also include difficulty speaking, swallowing, or walking.
- Multiple Sclerosis: While not immediately life-threatening, early diagnosis and treatment of multiple sclerosis can significantly impact the disease's progression and the patient's quality of life. Vertigo can be a presenting symptom.
Rare Diagnoses
- Acoustic Neuroma: A non-cancerous tumor on the nerve connecting the inner ear to the brain, which can cause vertigo, hearing loss, and tinnitus. It is rare but important to diagnose due to potential impact on hearing and neurological function.
- Otosclerosis: A condition in which there is abnormal bone growth in the middle ear, which can cause vertigo, hearing loss, and balance problems. It is less common and often diagnosed after other causes have been ruled out.
- Superior Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and hearing symptoms in response to sound or pressure changes.