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Beberapa kategori dari
dizziness
Vertigo adalah perasaan berputar dan
penglihatan bergerak, subyektif kalau
merasa dirinya bergerak dan obyektif kalau
sekelilingnya yang bergerak.
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Vertigo is a common complaint in the
general population
In population-based studies:
Vertigo occurs in 47% of people
Vertigo accounts for 2530% of dizziness
presentations
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Insidence
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Etiology of Vertigo
Tusa, RJ : Vertigo and Dizziness. In Aminoff, MJ, Daroff, RB (eds) : Encyclopedia of the
Neurological Sciences. Vol. IV, 2004, p. 651-655.
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Penyebab gangguan fungsi
keseimbangan
Infeksi (virus, bakteri),
Trauma
Tumor mengenai sistema vestibuler,
Gangguan peredaran darah, visual dan proprioseptik
Obat -obatan tertentu,
Proses ketuaan,
Benign Paroxysmal Positional Vertigo(BPPV),
Acute Vestibular Neuronitis (AVN) dan Menieres93% disease
kausa vertigo
7% sisanya dapat disebabkan oleh obat-obatan ( alcohol,
aminoglycosides, anticonvulsan, antidepressan, antihipertensi,
barbiturat, cocaine, diuretik, nitrogliserin, salisilat,
sedatif/hipnotik), Cerebro Vascular Disease, migraine,
labirintitis akut, multiple sclerosis, neoplasma intracranial.
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Vertigo can be of central or peripheral origin
Central
Involving structures in the
central nervous system
(e.g., cerebrum,
cerebellum, brainstem)
Peripheral
Involving structures
not part of the central
nervous system, most
frequently the inner
ear
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VERTIGO
PERIPHERAL vs CENTRAL
Likely aetiology
Symptom Peripheral Central
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Vertigo of Peripheral origin: causes
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Vertigo of Central origin: causes
Condition Details
Migraine Vertigo may precede migraines or occur
concurrently
Vascular disease Ischaemia or haemorrhage in
vertebrobasilar system can affect
brainstem or cerebellum function
Multiple sclerosis Demylination disrupts nerve impulses
which can result in vertigo
Vestibular epilepsy Vertigo resulting from focal epileptic
discharges in the temporal or parietal
association cortex
Cerebellopontine Benign tumours in the internal auditory
tumours meatus
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PATHOPHYSIOLOGY
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Maintaining Balance is dependent on input from
Visual, Vestibular and Somatosensory systems
Inner ear
Muscle and joint
(vestibular system)
sensory receptors
Central Nervous
system
BALANCE
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Physiology of EO
Vestibular system
Visus
Propriocepsis
Sensory information
COORDINATED
Oculomotor centre
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Balance dysfunction
BALANCE
dysfunction
Imbalance / dizziness 17
Pathogenesis of Vertigo
Vestibular system
Visus
Propriocepsis
Sensory information
Abnormal stimuli.
Excessive stimuli.
Discordant information
CENTRA
= Unknown pattern
Alarm warning
Oculomotor centre :
NYSTAGMUS Neuroveg centra
Muscles : DEVIATION
Become conscious
cortex VERTIGO
Affective component 18
Anatomy of Vestibular
Organ
Hain, TC, Helminski, JO : Vestibular Reflexs. In Aminoff, MJ, Daroff, RB (eds) : Encyclopedia
of the Neurological Sciences. Vol. IV, 2004, p. 657-660.
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Hair Cells
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The vestibular systemis the dominant
sensory input guiding balance
Utricle Otolith
Semicircular Saccule organs
canals
Vestibular nerve
Ampullae Cochlea
Sensory hair cells within the inner ear provide information on the
position and movement of the head 21
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Neurophysiology of Hair Cells
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Mechanism of Transduction
Bear, MF, Connors, BW, Paradiso, MA : Neuroscience Exploring The Brain Williams &
Wilkins, Baltimore, 1996, p. 272-288.
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Impuls Transmission
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Sign and Symptoms of EO Disfunction
Guedry, FE : Motion Sickness and its relation to some forms of spatial orientation :
Mechanisms and theory. AGARD Lecture series. 175. 1991, p.2.1-2.30.
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DIAGNO
SIS
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Diagnosis of Vertigo
1.History
Sensation, onset, duration, course, head/body position
Past history, medication.
2.Physical examination
General and neurologic examinations
Bed-side Neuro-otologic testing:
Postural tests: Romberg, Fukuda/Unterberger, past-
pointing test.
Eye movement tests: Dix-Hallpike, head thrust, head
shaking
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b) Onset :
mendadak, banyak terjadi pada vertigo perifer
bertahap pada vertigo sentral
c) Intensitas
Ringan / sedang, banyak dijumpai pada vertigo
sentral
Berat, ada gangguan fungsi otonom, banyak
dijumpai pada vertigo perifer
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B. Pemeriksaan Fisik
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Perbedaan nystagmus sentral dan perifer
N
Nystagmus Vertigo Sentral Vertigo Perifer
o
Arah Berubah ubah Horizontal /
1.
horizontal Rotatoar
2. Sifat Unilateral / bilateral Bilateral
Test Posisional
- Latensi Singkat Lebih lama
3. - Durasi Lama Singkat
- Intensitas Sedang Larut / sedang
- Sifat Susah ditimbulkan Mudah ditimbulkan
Test dengan Dominasi arah Sering ditemukan
rangsang ( kursi Jarang ditemukan
4. putar,irigasi
telinga)
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3. Provokasi test :
Untuk penyebab tertentu seperti :
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4. Pemeriksaan neurologi rutin Termasuk di sini :
Nn Kranialis , bila ada gangguan sangat
mungkin ada lesi di batang otak atau
serebellopontin area
Reflex kornea terganggu pada tanda awal tumor
serebellopontin
Vertigo dengan penurunan pendengaran lesi
pada Nn VIII seperti Acoustic Neurona
Parese N.VII sesisi dan vertigo dan migren
sering herpes zoster otikum
Motorik
Sensorik
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5. Pemeriksaan radiologi
CT-Scan kepala : perdarahan atau infark
serebellum .
MRI Kepala : perdarahan / infark
serebellum, acoustik neurinoma, multiple
sclerosis.
Angiografi : insuffisiensi sistem vertebro
basiler
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6. Pemeriksaan BERA / Audiometri : Membantu
menentukan letak lesi
7. Pemeriksaan lainnya :
Pemeriksaan glukosa darah untuk
Hiperglikemia
EKG
Ekstra sistole
Gangguan Irama
Bradikardi
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Differential Diagnosis
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Differential Diagnosis Penderita Vertigo
Etiologi Gejala Gejala yang Tanda Klinis
berhubung
an
PERIFER
1 Benigna Serangan Vertigo yang Saat Posisi kepala
Paroxysma singkat, pada posisi serangan, tertentu
l Posisional tertentu dan mudah mual, merangsang
Vertigo diulangi muntah vertigo
2 Labyrinthit
is Sedang / berat pada Tuli ringan / Vertigo
A.Serous posisi tertentu . sedang, Horizontal,
Didahului infeksi suhu badan tanda tidak
telinga, hidung, normal berat
tenggorokan
B. Acut Tuli berat
Superaktif Vertigo dengan adanya cepat terjadi gejala berat
infeksi superaktif di mual dan serius pada
telinga muntah media acut
disertai panas
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3 Penyakit Vertigo Rotatoar Mual, Nystagmus
Differential Diagnosis Penderita Vertigo
Central
4 Multiple - Vertigo berat - mual / - Nystagmus
Sclerosis - gangguan muntah berat horizontal / vertigo
keseimbangan - penglihatan rotatoar
kabur - Bilateral
Opthalmoplegi
- gerakan mata
ataksik
5 Epilepsi Sebagai gejala Gangguan Gangguan aphasia
Lobus prodromal / memory / sementara
temporal utama halusinasi 46
TREATMENT
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PENATALAKSANAAN
CENTRAL CAUSE
Migraine Betablockers, calcium channel blockers, tricyclic amines
1. ANTIVERTIGO
Vestibular Suppressant
1. Ca antagonist : Flunarizin
2. Vasodilator : Betahistine
3. Tranquilizer : diazepam, haloperidol, sulpiride
4. Antihistamin: Difenhidramine, meclizine.
5. CNS stimulant: ephedrin, amphetamine
2. Neurovegetative
Antiemetic
1. Anticholinergic: atropine, scopolamine
2. Phenotiazine: Prochlorperazine, metoclopramide.
3. Psychoaffective
Clonazepam for anxiety and panic attack
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Antivertigo Drugs
Betahistine:
For peripheral and central vertigo
promotion and facilitation of central vestibular compensation
Ginkgo biloba:
For peripheral and central vertigo
Accelerates postural and locomotorbalance and occulomotor
function and recovery
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VESTIBULAR REHABILITATION EXERCISE
Visual-vestibular interaction
Conditioning activities
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SELAMAT BELAJAR
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