Benign paroxysmal positional vertigo differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating [Disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

OR

As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Acute onset Recurrency Nystagmus Hearing problems
Peripheral
BPPV + + +/−
  • + Dix-Hallpike maneuver
  • Dix-Hallpike maneuver
  • May be associated with nausea, vomiting, and gait instability
Vestibular neuritis + +/− + /−

(unilateral)

  • + Head thrust test
  • History/ Physical exam
  • May be associated with nausea, vomiting, gait instability and previous upper respiratory infection
HSV oticus + +/− +/− + VZV antibody titres
  • In Magnetic resonance imaging with gadolinium dye we may have enhancement of the facial nerve and cranial nerve VIII
  • History/ Physical exam
  • May be associated with otalgia, dry mouth, and dry eyes
Meniere disease +/− + +/− + (Progressive)
  • Sensorineural hearing loss
  • In CTscan we may see small or invisible vestibular aqueduct
  • History/ Physical exam/ Rulling out other diagnoses
  • May be associated with nausea, vomiting, and tinnitus
Labyrinthine concussion + +
  • high frequency hearing loss
  • We may see other evidences of head trauma or temporal bone fracture
  • History/ Physical exam
  • It happens following blunt head trauma
  • May be associated with dizziness or tinnitus
Perilymphatic fistula +/− + +
  • Tullio phenomenon
  • CT scan may show fluid around the round window recess
  • History/ Physical exam/Imaging
  • Can be a complication of a stapedectomy, head injury, or heavy lifting
  • It may be provoked by sneezing, lifting, straining, coughing, and loud sounds
Semicircular canal

dehiscence syndrome

+ +

(air-bone gaps on audiometry)

  • Tullio phenomenon
  • CT scan may show defect in the arcuate eminence of the superior semicircular canal
  • History/ Physical exam/Imaging
  • It may be provoked by Valsalva maneuver, coughing, and sneezing
Vestibular paroxysmia + + +/−

(Induced by hyperventilation)

  • impaired caloric testing
  • It may be provoked by head turn or other action
Cogan syndrome
Vestibular schwannoma
Otitis media
Aminoglycoside toxicity
Recurrent vestibulopathy +
Central
Vestibular migrain +
Epileptic vertigo +
Multiple sclerosis
Brain tumors
Crebellar infarction/hemorrhage +
Brain stem ischemia +
Chiari malformation
Parkinson

References

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