The Current Diagnostic And Treatment of Vertigo Eva Dewati Divisi neuro-otologi dan Neuro-oftalmologi Departemen Neurologi FKUI -RSCM

Diagnostik Terapi

VERTIGO Vertigo  ilusi dimana seseorang merasa dirinya bergerak terhadap sekitarnya atau lingkungan yang bergerak terhadap dirinya (Brandt T, Dietrich M, Strupp M. Vertigo and Dizziness 2013)

VERTIGO ↓ Simptom ETIOLOGI >>

VERTIGO VESTIBULAR Central Peripheral Involving CNS structures: - Brainstem Cerebellum - Cerebrum Peripheral Involving: Inner ear - Vestibular nerve Vertigo can be of central or peripheral origin Vertigo can result from a diverse range of aetiologies, originating centrally or peripherally. Central causes of vertigo involve structures within the central nervous system (cerebrum, cerebellum, brainstem or connecting white matter) that process information from the vestibular system and other areas involved in balance. Peripheral causes of vertigo involve dysfunction in areas that are not part of the central nervous system, for example, the inner ear. Central causes of vertigo are unusual (Hain & Uddin 2003); peripheral causes are more common. References Baloh RW. Vertigo. Lancet 1998;352:1841–6. Hain TC, Uddin M. Pharmacological Treatment of Vertigo. CNS Drugs 2003;17:85–100. Mukherjee A, Chatterjee SK, Chakravarty A. Vertigo and dizziness – a clinical approach. JAPI 2003;51:109–101. Puri V, Jones E. Childhood vertigo: a case report and review of the literature. J Ky Med Assoc 2001;99:316–21. Salvinelli F, Firrisi L, Casale M, et al. What is vertigo? Clin Ter 2003;154:341–8. Strupp M, Arbusow V. Acute vestibulopathy. Curr Opin Neurol 2001;14:11–20. Baloh RW. Lancet 1998;352:1841–6. Mukherjee A et al. JAPI 2003;51:1095-101. Puri V, Jones E. J Ky Med Assoc 2001;99:316–21. Salvinelli F et al. Clin Ter 2003;154:341–8. Strupp M, Arbusow V, Curr Opin Neurol 2001;14:11–20.

VERTIGO PERIFER vs SENTRAL Gejala Peripheral Central Awitan Mendadak Perlahan Mual, muntah Berat Bervariasi Gejala pendengaran Sering Jarang Gejala Nerologik - Kompensasi/resolusi Cepat Lambat Distinguishing peripheral and central peripheral causes of vertigo Vertigo can result from peripheral or central dysfunction. While the overall presenting symptom (e.g., an illusion of rotation) may be the same regardless of the cause, a number of features can provide an indication as to the location of the specific dysfunction. For example, peripheral causes usually result in vertigo of a sudden onset, with nausea and vomiting commonly reported; neurological symptoms and changes in consciousness are rare. In contrast, vertigo due to central causes is more likely to have a gradual onset and a persisting duration accompanied by severe imbalance and other neurological symptoms. Identifying the underlying aetiology is paramount to appropriate management. References Baloh RW. Differentiating between peripheral and central causes of vertigo. Otolaryngol Head Neck Surg 1998;119:55–9. Puri V, Jones E. Childhood vertigo: a case report and review of the literature. J Ky Med Assoc 2001;99:316–21. Baloh RW. Et all. Clinical Neurophysiology of the Vestibular System. 2011.

Vertigo  subyektif Nistagmus  objektif

Nistagmus pada Lesi Vestibular Perifer vs Sentral Nistagmus Perifer Sentral Arah Unidireksional Bidireksional direction-fixed direction-changing Tipe Horisontal + rota- Bisa semua jenis: tori horisontal,rotatori, vertikal

Pemeriksaan Nistagmus Bedsisde FRENZEL’S GLASSES M GLASSES

Downbeat Nystagmus.mp4 Upbeat Nystagmus.mp4 Horizontal Nystagmus.mp4 VID-20130325-00005.3GP

HINTS Kattah dkk 2009  HINTS Kelainan vestibular akut Head Impulse Test (HIT) Nystagmus Test of Skew (TS) (celebisoy N. The clinical examination of the dizzy patient. EFNS 2014)

02.13 - Abnormal head thrust test to the right.mpg

TERAPI Causal Simptomatk : Betahistin, Flunarizine, Cinnarizine BPPV  Epley manuver, Semont manuver Latihan vestibular : - Brandt – Darroff - Cawthorne Cooksey exercise (Bronstein AM. Vertigo and imbalance. 2013)

Kesimpulan Vertigo  simptom, etiologi >> Diagnostik  anamnesis dan PF yang teliti Terapi  causal, simptomatik, latihan vestibular