Differential diagnosis
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DIFFERENTIAL DIAGNOSIS:
1)Vestibular Migraine:
Pathophysiology: Vestibular migraine is thought to involve abnormal activation of the vestibular system in response to migraine triggers. It’s related to the central nervous system and may involve changes in neurotransmitters and blood flow in the brain.
Symptoms:
Vertigo: Vestibular migraine presents recurrent vertigo attacks, often accompanied by other migraine symptoms such as headache, photophobia, and phonophobia.
Hearing Fluctuations: While hearing fluctuations can occur in vestibular migraines, they are not typically a prominent feature. This patient’s hearing loss worsening during vertigo episodes is less typical of vestibular migraine.
Tinnitus: can be associated with vestibular migraine, but it’s often not the primary symptom.
Aural Fullness: Aural fullness is not a characteristic symptom of vestibular migraine.
Rationale for Diagnosis: While vestibular migraine shares some features with this patient’s presentation (vertigo), the pronounced hearing fluctuations and aural fullness make Meniere’s disease a more likely diagnosis.
2)Benign Paroxysmal Positional Vertigo (BPPV):
Pathophysiology: BPPV is caused by displaced calcium crystals in the inner ear, specifically the semicircular canals. When these crystals move, they trigger brief episodes of vertigo.
Symptoms: BPPV primarily presents with brief episodes of vertigo triggered by head movements (e.g., rolling over in bed). It usually doesn’t cause hearing loss, tinnitus, or aural fullness.
Rationale for Diagnosis: BPPV can be ruled out due to the presence of hearing fluctuations and aural fullness, which are not typical of BPPV.
3)Acoustic Neuroma:
Pathophysiology: Acoustic neuroma, or vestibular schwannoma, is a slow-growing benign tumor arising from the vestibular nerve. It can compress adjacent structures in the internal auditory canal.
Symptoms: Acoustic neuroma typically presents with gradual, progressive unilateral sensorineural hearing loss without vertigo. Tinnitus may occur but is usually not associated with vertigo attacks.
Rationale for Diagnosis: While acoustic neuroma should be considered, the episodic nature of vertigo attacks and the presence of aural fullness and tinnitus during these attacks make Meniere’s disease a more likely diagnosis
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