Professional Documents
Culture Documents
Vertigo: Riki Sukiandra Neurology Department Faculty of Medicine Riau University 2012
Vertigo: Riki Sukiandra Neurology Department Faculty of Medicine Riau University 2012
Riki Sukiandra
Neurology Department
Faculty of Medicine
Riau University
2012
PENDAHULUAN
• DEFINISI:
Vertigo adalah perasaan penderita merasa
dirinya atau dunia berputar
• ETIOLOGI
1. Otologi:
• 24-61% kasus
• Benigna Paroxysmal Positional Vertigo (BPPV)
• Meniere Desease
• Parese N VIII Uni/bilateral
• Otitis Media
2. Neurologik
• 23-30% kasus
• Gangguan serebrovaskuler batang otak/ serebelum
• Ataksia karena neuropati
• Gangguan visus
• Gangguan serebelum
• Gangguan sirkulasi LCS
• Multiple sklerosis
• Malformasi Chiari
• Vertigo servikal
3. Interna:
•+/- 33% karena gangguan kardio
vaskuler
• tekanan darah
•Aritmia kordis
•Penyakit koroner
•Infeksi
• < glikemia
•Intoksikasi Obat: Nifedipin, Benzodiazepin,
Xanax,
4. Psikiatrik
• > 50% kasus
• Klinik dan laboratorik : dbn
• Depresi
• Fobia
• Anxietas
• Psikosomatis
5. Fisiologik
• Lihat dari ketinggian
PATOFISIOLOGI VERTIGO
Pituitary Increased
Secretion of
Motion Vestibular Vestibular ADH, ACTH,
stimuli Apparatus Nuclei GH, PRL
CTZ Autonomic
centres
SWEATING
PALLOR
Somatosensory Decreased Gastric
Receptors Vomiting centre motility,
Cardiovasculer &
Inspiratory changes
VOMITING
NORMAL PROCESSING
Vestibular system
Visus
Propiocepsis
Sensory information
= coordinated
CENTRA = known pattern
Oculomotor centra
Stabilization of visual field
Muscles of the body
Static and kinetic equilibrium
ABNORMAL PROCESSING
Vestibular system
Visus
Propiocepsis
Sensory information
=abnormal
=Excesive
stimuli
=Discordant information
CENTRA
= unknown patern NEUROVEG.
ALARM CENTRA
WARNING Oculomotor centra: NISTAGMUS
Muscles : DEVIATION
CORTEX BECOMES CONSCIOUS
AFFECTIVE COMPONENT VERTIGO
Head Acceleration Head angular Velocity Endolymph Displacement
Synaptic Action
Generator Potential
Primay Afferent
Action Potentials
CNS Ket:
CNS: Central Nervous System
VOR: Vestibulo Ocular Reflex
Perception VOR Posture
DIAGNOSIS VERTIGO ANAMNESIS
KRONIS BERULANG
(-)
TD. TELINGA TD. TELINGA
(-) (+)
• Co R
• A SCL • Obat Osteofit Cervical
• > Ventilasi
• Trauma Cervical
•PEMERIKSAAN NEUROLOGIS:
• Kesadaran
• Nn. Craniales
• Motorik
• Sensorik
• serebelum
• PEMERIKSAAN KHUSUS
• Heart rate + irama
• Palpase a. Carotis
• Auscultasi bising a. Carotis
• Romberg test
• Tandem gait
• STIMULASI VERTIGO
• Hipotensi ortostatik
• Manuver valsava
• Putar Kepala
• Nylen-Barany test
• Kalori test
• N. OPH
• N.OTOL
Dix-Hallpike maneuver (used to diagnose benign paroxysmal positional vertigo).
This test consists of a series of two maneuvers: With the patient sitting on the
examination table, facing forward, eyes open, the physician turns the patient's
head 45 degrees to the right (A). The physician supports the patient's head as
the patient lies back quickly from a sitting to supine position, ending with the
head hanging 20 degrees off the end of the examination table. The patient
remains in this position for 30 seconds (B). Then the patient returns to the
upright position and is observed for 30 seconds. Next, the maneuver is repeated
with the patient's head turned to the left. A positive test is indicated if any of
these maneuvers provide vertigo with or without nystagmus.
PARAMETER RESPON NORMAL
• MORFOLOGI RESPON
• Yang menarik adl gelombang IV dan V sering
bercampur bersama menjadi apa yang disebut
kompleks IV-V .
• Variant-variant komplek IV-V adl:
a. Puncak tunggal tanpa pemisahan gel. IV dan V
b. Pemisahan gelombang IV dan V dimana IV lebih
pendek dari V
c. Pemisahan gelombang IV dan V dimana IV lebih
tinggi dari V
d. Gelombang IV naik di atas gel V
e. Gelombang V naik diatas gel IV
f. Gelombang terpisah sama tinggi
DIFERENSIAL DIAGNOSIS
Beda Vertigo Neurogenik, Otogenik atau Psikogenik
Vertigo Otogenik Neurogenik
I. VERTIGO Sering ditemukan rotatory Sering non Rotational
1. Tipe directional Horisontal, Horisontal, Rotatory dan
2. Arah Rotatory bentukan oscillopsia,
scotoma
II PEMERIKSAAN FISIK
a. Perubahan Posisi Dipengaruhi perubahan Dipengaruhi gerakan leher
posisi kepala/tubuh
b. Gangguan gait Jarang/tidak ada Sering ada
c. Gangguan fungsi Selalu ada Tidak/jarang terjadi
otonom
d. Keluhan lain Tinitus, tuli Gangguan kesadaran
III. PEMERIKSAAN NISTAGMUS
a. Arah Indirectional Bidirectional
b. Jenis Horisontal atau Horisontal Rotatory vertikal, downbeat
Rotatory up beat
c. Fiksasi mata menghambat Tidak menghambat
d. Posisional Sukar diulang, Mudah diulang,
nistagmus latensi lama singkat
e. Eye tracking Sinusoid Saccadic/ ataxic
f. Kalori Unilateral weakness Bilateral weakness
IV. PEMERIKSAAN VESTIBULO SPINAL
a. Rambert- test mata
terbuka Normal Abnormal
tertutup Abnormal Abnormal
b. Writing test Deviasi abnormal Ataxic/ gelombang
c. Ataksia Tidak ada Sering ada
d. Finger to finger test Normal Abnormal