Peripheral causes
Benign paroxysmal positional vertigo (BPPV)
Vestibular neuritis/neuronitis
Acute labyrinthitis
Meniere disease
Otosclerosis
Otitis media
Mastoiditis
HeartHypertrophic cardiomyopathy; Cardiac tamponade; Atrial myxoma; Arrhythmias; Myocardial infarction; Valvular heart disease,
Aortic stenosis; Aortic dissection; Subclavian Steal
GI bleeding; Anemia;
Pulmonary embolus
Hyperventilation from multiple causes e.g. infection in lungs.
Ototoxic drugs (e.g. gentamicin, streptomycin)
Allergies

Central causes & systemic Causes with central effects
Migrainous vertigo (Vestibular migraine)
Cerebrovascular disease (infarction/hemorrhage): Brainstem, cerebellum, or cerebral cortex. Especially a stroke affecting the vertebrobasilar system. Vertebral artery dissection.
Vertebrobasilar artery insufficiency
Cerebellopontine angle and posterior fossa meningiomas: caused by vestibular schwannoma (i.e., acoustic neuroma), infratentorial ependymoma, brainstem glioma, medulloblastoma, or neurofibromatosis
Orthostatic hypotension
Vasovagal; Valsalva; Carotid hypersensitivity; Cough, micturition, defecation
Medication-induced: antihypertensives, antidepressants, gentamicin, furosemide, aminoglycosides, phenytoin, alcohol, aspirin, diazepam, illicit drugs, etc.
Psychiatric: Anxiety; Panic attack; depression, psychogenic (ventilation, hysteria), bipolar disorder
Autonomic insufficiency
Trauma: Post-concussion syndrome.
Barotrauma, ruptured oval window, perilymph leak
Neurologic disease: Multiple sclerosis; Seizure (especially temporal lobe epilepsy), pseudoseizure; Parkinson disease
Endocrine / Metabolic: Adrenal insufficiency (Addison’s disease); Hypoglycemia
CNS Infection – Meningitis
Hypoxia
Elderly multifactorial
Hypotension / severe HTN

 

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**Medication induced and psychiatric causes are diagnoses that you use after excluding other treatable causes.

Thinking through the differential diagnosis
Dividing the causes into peripheral and central causes is a good way to organize the differential.
Vertigo also comes from disease of the auditory system (peripheral and central)

An excellent way to divide the differential diagnosis of dizziness is to use the differential diagnosis grid. The anatomic regions could be peripheral and central and the mechanisms will be VINDICATED MEN.

Further reading

Acta Otolaryngol. 2014 Feb;134(2):140-5. https://www.ncbi.nlm.nih.gov/pubmed/24308666

Am Fam Physician. 2017 Feb 1;95(3):154-162. http://www.aafp.org/afp/2017/0201/p154.html

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