- Ernawati -

Pendahuluan
Ad: perasaan berputar bedakan dg dizziness *rasa goyang/tidak stabil

True vertigo: Keluhan subyektif rasa berputar (px beputar/sekelilingnya berputar ggn vestibuler

Etiologi
Drugs
Alcohol Aminoglycosides Anticonvulsants Antidepressants Antihypertensives Barbiturates Cocaine

( Slowly progressive Unilateral/Bilateral)

Klasifikasi CENTERAL VESTIBULAR CAUSES

Brain stem or cerebellum

PERIPHERAL VESTIBULAR CAUSES

Labyrinth or vestibular nerve

Central
Cerebellopontine

Peripheral
Acute

angle tumor Cerebrovascular disease Migraine Multiple sclerosis

labrynthitis Vestibular neuritis BPPV Cholestotoma Meniers disease Ostosclerosis Perilymphatic fistula

Sesuai kejadian
spontan posisi kalori

Pembahasan.. Vertigo spontan

Timbul tanpa rangsangan Rangsangan ok peny.sendiri misal: peny.meniere ok tek endlimfa

Vertigo posisi
Timbul ok perubahan posisi kepala Perangsangan kupula kanalis semisirkularis ok debris kotoran yg menempel pd kanalis semisirkularis/kel.servikal

Vertigo kalori
Timbul saat tes kalori Agar dpt membandingkan vrtigo ini dg serangan yg pernah dialami sama keluhan benar beda keluhan sebelumnya diragukan

Diagnosi

Anamnesis :

Ciri-ciri, sifat dan lama vertigo, faktor pencetus Gejala yang menyertai Penyakit sistemik hipotiroid, DM, penyakit kardiovaskuler, gangguan penglihatan,dll.

Typical Duration of Symptoms for Different Causes of Vertigo

Duration of episode A few seconds stages of Several seconds to a few minutes Several minutes to one hour Hours Days sclerosis Weeks improvement) Suggested diagnosis Peripheral cause: unilateral loss of vestibular function; late acute vestibular neuronitis; late stages of Mnire's disease

Benign paroxysmal positional vertigo; perilymphatic fistula

Posterior transient ischemic attack; perilymphatic fistula Mnire's disease; perilymphatic fistula from trauma or surgery; migraine; acoustic neuroma Early acute vestibular neuronitis*; stroke; migraine; multiple Psychogenic (constant vertigo lasting weeks without

*-Vertigo with early acute vestibular neuritis can last as briefly as two days or as long as one week or more.

Distinguishing Characteristics of Peripheral vs. Central Causes of Vertigo Feature Nystagmus Peripheral vertigo Combined horizontal and torsional; inhibited by fixation of eyes onto object; fades after a few days; does not change direction with gaze to either side Imbalance Nausea , vomiting Mild to moderate; able to walk May be severe Central vertigo Purely vertical, horizontal, or torsional ; not inhibited by fixation of eyes onto object; may last weeks to months ; may change direction with gaze Severe; unable to stand still or walk Varies

Hearing loss, tinnitus

Nonauditory neurologic symptoms

Common Rare

Rare Common

Latency following provocative diagnostic Longer (up to 20 seconds) maneuver)

Information from references 14 and 15.

Shorter (up to 5 seconds)

Pemeriksaan Fisik

Pmx THT umum Tes garpu tala (pemeriksaan fungsi pendengaran) Tes keseimbangan : romberg test, stepping gait. Pmx neurologi

Pmx adanya nistagmus tes kalori, manuver hallpike.

Pmx psikiatrik bila diduga ada faktor psikogen

Clues to Distinguish Between Peripheral and Central Vertigo Clues

Findings on Dix-Hallpike maneuver Severity of vertigo Duration of nystagmus Fatigability* Habituation Other findings Postural instability Hearing loss or tinnitus Other neurologic Symptoms Able to walk; unidirectional instability Can be present Absent Falls while walking; severe instability Usually absent Usually present

Peripheral vertigo
Latency of symptoms and nystagmus 2 to 40 seconds Severe Usually< 1 minute Yes Yes

Central vertigo
None

Mild Usually>1 minute No No

*-Response remits spontaneously as position is maintained. -Attenuation of response as position repeatedly is assumed. Information from references 3 and 4.

 Pemeriksaan

Penunjang :

Tes audiogram Elektronistagmografi CT-scan MRI

Penatalaksanaan
1.

Vestibuler sedative

Derivat antihistamin (ant H1) Dimenhydrinate (dramamin) po bila muntah hebat inj Prometazine Cinnarizine Derivat fenotiazin (bila muntah) Prochlorperazine Bila muntah hebat dehidrasi

2.

Infus

Indikasi MRS :

Vertigo berat dan progresif Vertigo pertama kali dan berat curiga stroke