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PATHOPHYSIOLOGY
AND MANAGEMENT OF
VERTIGO
Meiti Frida, MD
Neurology Department M Djamil Hospital/Andalas
University
OUTLINE
1. Introduction
Definition vertigo
Etiology
2. Pathophysiology vertigo
3. Diagnosis vertigo
4. Treatment vertigo
DEFINITION
Vertigo
-Common medical problem
-30% of people average 65 years
-20% of all older person seek medical
advice
Vertigo : The sensation of spinning or
evolving
while the body is stationary with respect
to the earth or surrounding
ETIOLOGY
1.Otology
24 61 % case
Benign Paroxysmal Positional Vertigo
(BPPV)
Meniere Disease
Parese N VIII
Otitis media
2.
Neurology
23 30% case
Cerebrovascular disorder (TIA ) Stroke
Neuropathy ataxia
Multiple sclerosis
Servical disorder
Tumor (acustic neuroma)
Chiari malformation
Cerebellum Disorder
3. Systemic Cause
33% cardiovaskuler disorder
Blood pressure
Arithmia cordis
Uremia
Glycemia
Infection
Drug intoxication : Nifedipin,
benzodiazepin, xanax
4. Psychiatry
> 50 % case
Depression
Fobia
Anxietas
Psichosomatic
Pathophysiology Vertigo
Receptor
Eye
Vestibuler
Proprioceptiv
e
Data
Processing
CNS
Efector
Scletal Muscle
Eye
Servical
Body
Extremities
NORMAL PROCESSING
Vestibular system
visus
Propriocep tive
Sensory
Information
= coordinated
Central
= known pattern
Oculomotor
central
Muscles of the
body
static and kinetic equilibrium
Head
Acceleratio
n
Endolymph
Displacement
Head Angular
Velocity
Cilia
Bending
Cupular
Angle
Receptor Cell
Potential
Synaptic
Action
Generator
potential
Primary
afferent
action
potential
CNS
Ket :
CNS : central Nervous System
precept
VOR : Vestibulo Ocular Reflex
io
VOR
postur
e
DIAGNOSING VERTIGO
Anamnesis
What symptom you have for example wether you
feel light headed or if your surrounding are spinning
How often your symptom occur
How long you symptoms usually lost for
If your symptom are affecting your daily activities
for example, wether you are unable to walk during
on episode of vertigo
Have a family history of migraine or meniere
disease
Have recently had an infection or head injury
Physical examination
Blood pressure : hipotensi orthostatic
Heart rate rythm
Bruit carotis
Neurology examination
Awarness
Nn Cranialis
Motoric
Sensoric
Serebelum
Other Test
Hallpike`s
Manouvre
Manuver Valsava
Nylen Barany Test
Calori Test
Hallpike`s Manouvre
Romberg test
I. VERTIGO
Vertigo
Otogenik
Neurogenik
1. Type
Rotatory
directional
horizontal
Non rotational
2. Direction
Rotatory
Horizontal,
rotatory
scotoma
Influence by
head
position/body
Influence by
neck motion
often
Rarely
Rarely
c. Autonoum Always
dysfunctio
n
Tinnitus,
d. Others
hearing loss
symptoms Deficit
neurologic focal
(-)
Impaired
consciousness
Deficit
neurologic
focal (+)
Indirection
Bidirection
b. Type
Horizontal or
rotatory
horizontal
Rotatory
vertikal, down
beat, up beat
c. Eye fixation
blocking
Non blocking
d. Nystagmus
positional
e.
sinusoid
Saccadic/ataxic
Unilateral
weakness
Bilateral
weakness
Eye
tracking
f. Calory
Normal
abnormal
Abnormal
Abnormal
b. Writing test
Deviasi abnormal
Ataxia / wave
c. Ataxia
none
often
Abnormal
e. Past pointing
test
Abnormal both
hands
Abnormal side of
lesion
f. Stepping
Deviation of side
of lesion
Erratic deviation
g. Walking
eye closed
There are
deviation
Treatment of Vertigo
I. Symptomatic Treatment
Anti histamine
Treatment
Dymen hydrinate
3 x 50mg/day
Cinnarizine
3 x 25mg/day
Ca-entry blocker
Flunarizine
3 x 5- 10mg/day
Histaminic
Betahistine (merislon)
3 x 8mg/day
Fenotiazine
Chlorpromazine
3 x 25mg/day
Metoclopramide
Primperan
3 x 10mg/day
Causative Treatment
Anti platelet agregation
Operatif
Tumor
Spondylosis servikalis
Epilepsi
Phenitoin
Carbamazepin
Migrain
Ergotamine
Flunarizine
Rehabilitatif Treatment
- Metode Brandt-Daroff
- Gait exercise
ZI-MING W, ET AL. THE EFFECT OF BETAHISTINE MESYLATE AS A TREATMENT TO VERTIGO INDUCED BY INNER
EAR ISCHEMIA. CHINESE SCIENTIFIC JOURNAL OF HEARING & SPEECH REHABILITATION 2007
Objective
To observe the effects of betahistine mesylate as a treatment to
benign positional paroxysmal vertigo (BPPV), posterior circulation
ischemia (PCI), migrainous vertigo (MV) and teenager benign
paroxysmal vertigo and to study the causal relationships of dosages
between betahistine mesylate 6 mg & 12 mg
Method
90 cases BPPV, PCI & MV @ 30 cases per disease & devided into
2 groups @ 15 cases per group.
Group 1: betahistine mesylate 6 mg 3x perday.
Group 2 : betahistine mesylate 12 mg 3x perday
duration of treatment for 1 month
Zi-ming W, et al. The Effect of Betahistine Mesylate as a Treatment to Vertigo Induced by
Inner Ear Ischemia. Chinese Scientific Journal of Hearing & Speech REhabilitation 2007
Total pasien n= 90
BPPV
30 pasien
PCI
30 pasien
MV
30 pasien
Grouping of patients
MRS 6 mg
MRS 6 mg
MRS 12 mg
MRS 12 mg
MRS 6 mgMRS 12 mg
15 patients
15 patients
15 patients
15 patients
15 patients
15 patients
Parameter
High stimulating rate of auditory brainstem
response (ABR)
Dizziness handicap inventory (DHI)
ABR & DHI be evaluated & compared before & after
adminstrationZi-ming
of betahistine
mesylate
W, et al. The Effect of Betahistine Mesylate as a Treatment to Vertigo Induced by
Inner Ear Ischemia. Chinese Scientific Journal of Hearing & Speech REhabilitation 2007
p<0.01
p<0.05
p<0.01
Kesimpulan: Efikasi ditunjukan oleh kedua grup baik 6 mg maupun 12 mg. Namun pada grup yang diberikan
Betahistine Mesylate 12 mg, 3 x 1 selama 1 bulan, terlihat perbedaan yang signifikan dibandingkan dengan 6 mg.
Zi-ming W,et al. The effect of betahistine mesylate as a treatment to vertigo induced by inner ear ischemia. 2007
mild
n=90
Kesimpulan: Efikasi ditunjukan oleh kedua grup baik 6 mg maupun 12 mg. Namun pada grup yang diberikan
Betahistine Mesylate 12 mg, 3 x 1 selama 1 bulan, terlihat perbedaan yang signifikan dibandingkan dengan 6 mg
dalam menurunkan tingkat keparahan vertigo dengan pengukuran DHI.
Zi-ming W,et al. The effect of betahistine mesylate as a treatment to vertigo induced by inner ear ischemia. 2007
Dari 2.254 pasien hanya 26 pasien (1.15%) yang melaporkan efek samping. Dosis 18mg
-36mg/hari
Conclusion
Vertigo is public health problem
especially in the elderly
Need anamnesis and examination
as well as the etiology of vertigo
Treatment depends on the subtype
and cause