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Central
Cerebellopontineangle tumor
Cerebrovasculardisease
Migraine
Multiple sclerosis
Peripheral
Acute labrynthitis
Vestibular neuritis
BPPV
Cholestotoma
Meniersdisease
Ostosclerosis
Perilymphatic fistula
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Sesuai kejadian
spontan posisi kalori
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Vertigo spontan Timbul tanpa rangsangan
Rangsangan ok peny.sendirimisal: peny.meniereoktek endlimfa
Vertigo posisi Timbul ok perubahan posisi kepala
Perangsangan kupula kanalis semisirkularis ok debriskotoran yg menempel pd kanalis semisirkularis/kel.servikal
Vertigo kalori
Timbul saat tes kalori
Agar dpt membandingkan vrtigo ini dg serangan ygpernah dialamisamakeluhan benarbedakeluhan sebelumnya diragukan
Pembahasan..
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Diagnosi
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Anamnesis : Ciri-ciri, sifat dan lama vertigo, faktor pencetus
Gejala yang menyertai
Penyakit sistemikhipotiroid, DM, penyakitkardiovaskuler, gangguan penglihatan,dll.
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Typical Duration of Symptoms for Different Causes ofVertigo
Duration of episode Suggested diagnosis
A few seconds Peripheral cause: unilateral loss of vestibular function; latestages of
acute vestibular neuronitis; late stages of Mnire's disease
Several secondsto a few minutes Benign paroxysmal positional vertigo; perilymphatic fistula
Several minutesto one hour Posterior transient ischemic attack; perilymphatic fistula
Hours Mnire's disease; perilymphatic fistula from trauma or surgery;migraine; acoustic neuroma
Days Early acute vestibular neuronitis*; stroke; migraine; multiplesclerosis
Weeks Psychogenic (constant vertigo lasting weeks withoutimprovement)
*-Vertigo with early acute vestibular neuritis can last as briefly as two days or as long as oneweek or more.
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Distinguishing Characteristics of Peripheral vs. Central Causes of Vertigo
Feature Peripheral vertigo Central vertigo
Nystagmus Combined horizontal and torsional; Purely vertical, horizontal, or torsionalinhibited by fixation of eyes onto object; ; not inhibited by fixation of eyes onto
object;fades after a few days; does not change may last weeks to monthsdirection with gaze to either side ; may change direction with gaze
Imbalance Mild to moderate; able to walk Severe; unable to stand still or walk
Nausea May be severe Varies
, vomiting
Hearing loss,tinnitus Common Rare
Nonauditory Rare Commonneurologicsymptoms
Latency followingprovocativediagnostic Longer (up to 20 seconds) Shorter (up to 5 seconds)maneuver)
Information from references 14 and 15.
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Pemeriksaan Fisik
Pmx THT umum
Tes garpu tala (pemeriksaan fungsi pendengaran)
Tes keseimbangan : romberg test, stepping gait.
Pmx neurologi
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Pmx adanya nistagmustes kalori, manuverhallpike.
Pmx psikiatrikbila diduga ada faktor psikogen
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Clues to Distinguish Between Peripheral and Central Vertigo
Clues Peripheral vertigo Central vertigo
Findings on Latency of symptoms NoneDix-Hallpike and nystagmus 2 to 40 seconds
maneuver
Severity of vertigo Severe Mild
Duration of nystagmus Usually< 1 minute Usually>1 minute
Fatigability* Yes No
Habituation Yes No
Other findings
Postural instability Able to walk; Falls while walking;unidirectional instability severe instability
Hearing lossor tinnitus Can be present Usually absent
Other neurologicSymptoms Absent Usually present
*-Response remits spontaneously as position is maintained.
-Attenuation of response as position repeatedly is assumed.
Information from references 3 and 4.
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Penatalaksanaan
1. Vestibuler sedative Derivat antihistamin (ant H1)
Dimenhydrinate (dramamin)pobilamuntah hebatinj
Prometazine Cinnarizine
Derivat fenotiazin (bila muntah)
Prochlorperazine
2. Infus Bila muntah hebatdehidrasi
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Indikasi MRS :
Vertigo berat dan progresif
Vertigo pertama kali dan beratcuriga stroke