Differential Diagnosis for Vertigo in an 81-year-old Female
Single most likely diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is the most common cause of vertigo in the elderly, resulting from the movement of calcium particles in the inner ear. The age of the patient and the nature of vertigo (often triggered by specific head movements) make BPPV a highly probable diagnosis.
Other Likely diagnoses
- Vestibular Neuritis/Labyrinthitis: Inflammation of the inner ear or the vestibular nerve can cause vertigo, and while less common than BPPV, it is still a frequent cause of vertigo in older adults.
- Meniere's Disease: Although it can occur at any age, Meniere's disease is another inner ear disorder that leads to vertigo, often accompanied by tinnitus, hearing loss, and ear fullness.
- Orthostatic Hypotension: While not directly a cause of vertigo, orthostatic hypotension can lead to dizziness upon standing, which might be mistaken for vertigo, especially in elderly patients with multiple comorbidities.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Posterior Circulation Stroke: Vertebrobasilar insufficiency or stroke can present with vertigo and is a medical emergency. Although less common, missing this diagnosis can have severe consequences, including death or significant disability.
- Transient Ischemic Attack (TIA): Similar to stroke, a TIA can present with vertigo among other symptoms and is a warning sign for a potential future stroke.
- Cardiac Causes (e.g., Arrhythmias): Certain cardiac conditions can cause dizziness or vertigo-like symptoms, especially in older adults, and require prompt attention.
Rare diagnoses
- Acoustic Neuroma: A benign tumor on the vestibular nerve can cause vertigo, hearing loss, and tinnitus. It is less common but should be considered, especially if other symptoms are present.
- Multiple Sclerosis: Although rare, multiple sclerosis can present with vertigo among a wide range of neurological symptoms.
- Autoimmune Inner Ear Disease: This is a rare condition where the immune system attacks the inner ear, leading to vertigo, hearing loss, and sometimes tinnitus.