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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