Differential Diagnosis for Vertigo Symptoms

Vertigo: Feeling like the room is spinning.

1. Meniere Disease: Recurrent episodes, Unilateral hearing loss and tinnitus (mechanical vibration with sound), feeling of ear fullness.
Caused by increased volume and pressure of endolymph with resulting vestibular and cochlear damage.
Tx: Restrict caffeine, sodium, nicotine, EtOH. Benzos, Antihistamines, antiemetics can relieve symptoms. Diuretics can also help for long-term management.

2. Benign paroxysmal positional vertigo (BPPV): Brief, intense episodes triggered by head movement, Dix-Hallpike maneuver causes nystagmus. Usually no tinnitus or hearing loss.

3. Vestibular neuritis: Acute, single episode that can last days, often follows viral syndrome, abnormal head thrust test.
Tx: None. Will resolve within several weeks.

4. Migraine: Vertigo associated with headache or other migrainous phenomenon (eg, visual aura), Symptoms resolve completely between episodes

5. Brainstem/Cerebellar Stroke: sudden onset, persistent vertigo; Usually other neurologic symptoms.

Less common:
6. Multiple Sclerosis: episodic vertigo, sensorineural hearing loss. Also paresthesias, weakness, visual disturbance, urinary incontinence.

7. Vestibular schwannoma: unilateral persistent, progressive sensorineural hearing loss. May also have tinnitus, imbalance.