Professional Documents
Culture Documents
Gejala
1.
Pusing berputar
2.
Defisit neurologis
3.
4.
5.
6.
7.
8.
9.
10
.
11
.
12
.
13
.
14
Serangan nya
Nystagmus
Demam (riwayat infeksi virus
respiratory atau ear)
Penggunaan Obat
BPPV
Inflamasi N.
Vestibular
(neuronitis)
Labhyrintithis
Menieres disease
+
sudden, <
1min
Penekanan N.
Vestibular
(schwanoma,
meningioma)
+
+++
kalau sdh
parah
(CN.V)
+
lama, bahkan
setelah infeksi
sembuh
+
+++
sensory
neural
+
+
(ke samping)
+++
+
+++
sembuh setelah
serangan, tp
memberat jika muncul
kembali
+++
+++
+++
+
Detik - min
Min - hours
+
sec - min
+
+++
+++
+++
+
+
Tidak simetris
.
15
.
16
.
Aspirin
Dix hall pike
Damage
Vestibular aja
Vestibular &
cochlear
BPPV
1. Classic BPPV involving the posterior semicircular canal is characterized by the following:
a. geotropic nystagmus with the problem ear down,
b. predominantly rotary nystagmus toward the undermost ear, latency of a few seconds, duration limited to less than 20 seconds,
c. reversal of nystagmus when the patient returns to an upright position, and a decline in response with repetitive provocation.
2. Treatment is often supportive as a large percentage of patients will have spontaneous resolution of their symptoms.
a. For those with persistent symptoms, the first line of treatment is
i. canalith repositioning maneuvers.
1. These maneuvers attempt to reposition the free-floating canalith particles from the semicircular canals to the utricle using gravity.
a. The Epley manoeuvre
b. Brandt-Daroff exercises
c. Semont
b. Patients with symptoms refractory to repositioning maneuvers may be candidates for singular neurectomy or posterior semicircular canal occlusion.
c. Obat tidak diberikan secara rutin pada BPPV. Malah cenderung dihindari karena penggunaan obat vestibular suppresant yang berkepanjangan hingga lebih dari 2
minggu dapat mengganggu mekanisme adaptasi susunan saraf pusat terhadap abnormalitas vestibular perifer yang sudah terjadi.
MENIEREs DZ
1. The exact cause of Meniere's disease is unknown (autoimmune ?). It may occur when the pressure of the fluid in part of the inner ear gets too high.
2. Typically, these patients complain of spontaneous episodic attacks of tinnitus, aural fullness, fluctuating hearing loss, and vertigo superimposed on a gradual
decline in hearing.
a. TRIAS: tinnitus + vertigo + tuli sensorineural pada nada rendah.
Attacks typically last minutes to hours; however, most commonly subside after 2 to 3 hours.
3. Diagnosis is established with a thorough history detailing the aforementioned complaints, possibly accompanied by nausea, vomiting, diaphoresis (keringetan )
i. Audiologic and vestibular testing is unreliable,
ii. May show caloric weakness on electronystagmography (ENG) and sensorineural hearing loss on audiography.
iii. MRI kepala dan kanal auditori internal
4. Treatment
i. Treating the fluid balance changing to a low-salt diet (< 1500mg /hari) and using a diuretic
ii. Drugs :
i. During attack:
1. Prochlorperazine (buccastem)
ii. Pencegahan:
3. Betahistine
5. Benzodiazepine
i. Surgery
Non-destructive surgery
Non-destructive surgery may be used if your hearing in the affected ear is
'socially adequate' (you can hear sounds that are below 50 decibels). This
type of surgery aims to change the progression of Mnire's disease by
reducing the severity and frequency of your symptoms.
Gentamicin should mainly damage the balance part of your ear, but there is a
risk it could it damage your hearing too.
Some surgeons prefer to apply the gentamicin directly to the inner ear during
a minor operation. This means they can control the exact dose of gentamicin
that enters your ear.
Destructive surgery
disease is limited
Destructive surgery is used to destroy the part of your inner ear that is
disease
permanent hearing loss in the treated ear so will only be considered if you
suggest it is effective
After the surgery, your other ear will take over your hearing and balance
functions.
Labyrinthitis
is an inner ear infection that causes the labyrinth (a delicate structure deep inside your ear) to become inflamed.
1. Symptoms:
a. present with complaints indicative of both vestibular and cochlear damage. Vertigo presents suddenly and is accompanied by hearing loss. ENG
may reveal nystagmus, and audiometry will reveal a sensorineural hearing loss or mixed hearing loss if middle ear effusion is present. Depending
on the source of infection, patients may also present with findings consistent with otitis media, mastoiditis, or meningitis.
2. Tatalaksana
a. mandiri
stop smoking
cut out noise and anything that causes stress from your surroundings
b. Medikamentosa :
Benzodiazepine
Benzodiazepines reduce activity inside your central nervous system. This
means your brain is less likely to be affected by the abnormal signals coming
from your vestibular system.
Corticosteroids
Corticosteroids such as prednisolone may be recommended if your
Vestibular SCHWANNOMA
1. Patients may present with episodic or positional vertigo, disequilibrium, tinnitus, and usually asymmetric hearing loss.
a. Early in the disease, when the tumor is small, patients complain of dizziness, hearing loss, and tinnitus, due to compression of the
vestibulocochlear nerve.
b. The slow growth often allows for central compensation, alleviating (membuat jd lebih ringan) vertigo.
c. With continued growth, the tumor can press against the facial or trigeminal nerve causing facial weakness and numbness, respectively.
d. Eventually, the tumor grows to a size where it compresses the brainstem and cerebellum causing truncal ataxia, dysmetria, disequilibrium, and
possibly death.
2. Diagnosis : MRI (NK or K) atau CT scan (kontrast)
3. Tatalaksana:
a. Surgery
b. Radiation therapy
c. Observation
Pembeda
Onset
Intensitas
Mual
muntah
Gannguan
pendengaran
Tinnitus
Defisit
neurologis
Nistagmus
Vertigo Perifer
Akut
Sedang - berat
Sering
Vertigo Sentral
Kronik
Ringan - sedang
Jarang
Sering
Jarang
Sering
Tidak ada
Jarang
Sering
Rotary / horizontal
Multidirectional
characterized as follows:
Gradual onset
Tend to be much less intense than those associated with peripheral
vertigo
CHECKLIST PF VERTIGO
XI
XII
KU:
, Kesadaran:
, TTV:
II, IV, VI
V
VII
VIII
IX, X
4. Motorik
Extrimitas atas :
Sendi bahu
Bicep
Triceps
Genggam jari
Extrimitas bawah
Pinggul
Hamstring
Ankle dorsi flexi
Patrick kontra Patrick
5. Refleks Fisiologis
6. Reflex patologis
Babinski chadog
Hoffman traumar
7. Sensorik
: raba
8. Propeoceptive
: posisi sendi