Vestibular neuronitis Semicircular canal infection Semicircular canal water penetration
Assessment of the dizzy patient,
Australian Family Physician Vol. 31, No. 8, August 2002
Central Vestibular Disorders Brain stem lesion Basilar artery migraine TIA Stroke MS Cerebellar lesions
Metastatic Tumor Meningioma
Assessment of the dizzy patient,
Australian Family Physician Vol. 31, No. 8, August 2002
Perbedaan Klinis Vertigo Vestibuler vs Non
Vestibuler Gejala
V. Vestibuler
V. Non Vestibuler
Sifat
berputar
Melayang, hilang keseimbangan, lightheaded
serangan
Episodik
kontinyu
Mual, muntah
++
Gangguan pendengaran
+/-
Gerakan Pencetus
Gerakan kepala
Gerakan obyek visual
Situasi pencetus
Ramai orang, lalu lintas macet,
supermarket
Perbedaan Klinis Vertigo Vestibuler
Tipe Perifer dan Tipe Sentral Gejala
T. Perifer
T. Sentral
Bangkitan Vertigo
Lebih Mendadak
Lebih Lambat
Derajat Vertigo
Berat
Ringan
Pengaruh gerakan kepala
Gejala Otonom (mual
dan muntah)
++
Gangguan pendengaran (tinitus, tuli)
Tanda Fokal Otak
Vertigo Berdasarkan Gejala
Klinis Vertigo yang paroksismal Vertigo yang kronis Vertigo yang serangannya akut, berangsur-angsur menghilang
Vertigo Paroksismal Serangan mendadak, beberapa menit atau hari, hilang sempurna, bisa muncul kembali, diantara serangan bebas sama sekali Vertigo jenis ini :
for the dizzy patient Chiropractic Technique, vol 6(4) Nov 1994
Non-episodic Non-positional
Episodic positional Benign positional
Cervicogenic
Vertebobasilar ischemia
sudden
sudden
gradual
Fades 30-60 seconds
persists
progression
Benign Paroxysmal Positional
Vertigo (BPPV) 20%
Brief episodes recurrent
Moderate to severe Associated with head position Gradually diminishes over a month or two No hearing loss Latency or delayed onset Positive Nylen-Barany maneuver Caused by otoconia (debris) floating in SC
Nylen-Barany / DixHallpike Patient seated, head turned 45 degrees Patient quickly lays supine Latency period, then horizontal or rotational nystagmus Nystagmus decreases after 10-20 seconds Affected ear is the side head is turned toward when nystagmus and vertigo occurs
Modified Epleys Maneuver Patient placed supine with head turned 45 degrees toward the affected ear (30 sec.) Dr. turns head 90 degrees so affected ear is up. (30 sec.) Patient rolls on to side, head looking toward the floor (30 sec.) Patient is lifted into sitting position Procedure is repeated until no nystagmus
Modified Epley Maneuver
Dizziness,Hearing Loss, and
Tinnitis R.W. Baloh, F.A. Davis Company 1998
Modified Epley Maneuver
Dizziness,Hearing Loss, and
Tinnitis R.W. Baloh, F.A. Davis Company 1998
Sermonts Maneuver Patient can be instructed to do this at home. Patient turns head 45 degrees away from the affected side Quickly lays down maintaining head position (4 minutes) Brought up and placed on other side with same head position. (4 min) Sit up normal
Sermonts Maneuver
Archives Otolaryngol Head Neck
Surgery, Vol 119, p452, 1993
Post Maneuver Instructions Patient waits 10 min. before leaving office. Other person drives them home. Sleep half-reclined 2-3 days. Avoid laying on bad side. Avoid extreme head extension for 2-3 days
Cervicogenic Vertigo Hx of neck trauma, muscle spasm Limited cervical ROM Positive chair rotation test (FitzRitson) Patients may complain of dysequilibrium (tilt) more than rotational vertigo Overstimulation of upper cervical proprioceptors May overlap BPPV or Menieres disease
Menieres Disease Sudden and recurrent (paroxysmal) attack of severe vertigo Low-tone hearing loss Low-tone tinnitis Sense of fullness in the ear Vertigo lasts for hours to a day then burn out Hearing loss may progress
Cause of Menieres Overproduction or retention of endolymph Possible autoimmune etiology Head trauma Previous infection Pregnant females are more prone
Management of Menieres Salt-restriction diet Diuretic therapy Cervical adjusting (overlaps with cervicogenic vertigo
Perilymphatic Fistula Hx of barometric pressure changes (airplane or weight lifting) Opening develops between middle and inner ear (oval window rupture) Rare cause of vertigo Bearing down reproduces Tx - surgical
Non-episodic Non-positional vertigo
Labyrinthitis
Acoustic neuroma
Cerebral hemorrhage
Labyrinthitis Sudden severe vertigo that last days to weeks Maybe nausea and vomiting Viral infection - no hearing loss Bacterial infection hearing loss
Acoustic Neuroma
Mild but constant hearing loss
Dizziness with possible tinnitis Gradual onset Benign schwannoma of 8th CN Other CN findings as tumor grows Surgical excision
Cerebral Hemorrhage
Sudden vertigo and nausea
Vomiting associated with a headache Inability to stand Nystagmus, nuchal rigidity, facial paralysis, ataxia, dysrythmia, small reactive pupils in 2/3 of HTNpatients
