diagnosis, pathophysiology and management of vertigo
TRANSCRIPT
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Meiti Frida, MD
Neurology Department M Djamil Hospital/AndalasUniversity
DIAGNOSIS,PATHOPHYSIOLOGY
AND MANAGEMENT OF
VERTIGO
geran Beach Hotel , Jan !th" #$%
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OUTLIN
!" Introdu#tion De$nition vertigo
tiology
%" &at'op'ysiology vertigo
(" Diagnosis vertigo
)" Treatment vertigo
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DFINITION
*ertigo
+ommon medi#al pro-lem
+(. o0 people average 12 years
+%. o0 all older person see3 medi#aladvi#e
*ertigo 4 T'e sensation o0 spinning orevolving5'ile t'e -ody is stationary 5it' respe#tto t'e eart' or surrounding
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%" Neurology %( 8 (. #ase ere-rovas#ular disorder ;TIA < =tro3e Neuropat'y ata:ia Multiple s#lerosis =ervi#al disorder Tumor ;a#usti# neuroma<
'iari mal0ormation ere-ellum Disorder
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(" =ystemi# ause(( #ardiovas3uler disorder>? 9lood pressure
Arit'mia #ordisUremia>? 6ly#emia
In0e#tionDrug into:i#ation 4 Ni0edipin,-en@odia@epin, :ana:
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)" &sy#'iatry 2. #ase
Depression
Fo-ia
An:ietas
&si#'osomati#
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&at'op'ysiology *ertigo
Be#eptor Data&ro#essing
0e#tor
• ye• *esti-uler
• &roprio#eptive
N= • =#letal Mus#le• ye
• =ervi#al• 9ody• :tremities
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NOBMAL &BO==IN6
Ve&t'()lar &*&te+
'&)&Pro-r'oce- t'e
=ensoryIn0ormation
entral
O#ulomotor
#entral
Mus#les o0 t'e-ody
C #oordinated
C 3no5n pattern
sta-ili@ation o0 visual $eld
stati# and 3ineti# euili-rium
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Hea.Accelerat'on
Hea. Ang)larVeloc't*
En.ol*+-hD'&-lace+ent
/'l'a
Ben.'ngRece-tor /ellPotent'al
S*na-t'c
Act'on
/)-)lar
Angle
Generator-otent'al
Pr'+ar*
a0erentact'on-otent'al
/NS
VOR-rece-t'o
-o&t)re
Eet 4N= 4 #entral Nervous =ystem*OB 4 *esti-ulo O#ular Bee:
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DIA6NO=IN6 *BTI6O
Anamnesis
• G'at symptom you 'ave 0or e:ample 5et'er you0eel lig't 'eaded or i0 your surrounding are spinning
• Ho5 o0ten your symptom o##ur
• Ho5 long you symptoms usually lost 0or
• I0 your symptom are ae#ting your daily a#tivities0or e:ample, 5et'er you are una-le to 5al3 duringon episode o0 vertigo
• Have a 0amily 'istory o0 migraine or menieredisease
• Have re#ently 'ad an in0e#tion or 'ead injury
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&'ysi#al e:amination
• 9lood pressure 4 'ipotensi ort'ostati#• Heart rate ryt'm
• 9ruit #arotis
Neurology e:amination
• A5arness
• Nn ranialis
• Motori#
• =ensori#
• =ere-elum
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Ot'er Test
• Hallpi3esManouvre
• Manuver *alsava
• Nylen 9arany Test
• alori Test
Hallpi3es Manouvre
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• Hearing test4 Tinnitus,
Hearing Loss – Audiometry Test – Tuning 0or3 Test
• MBI s#an 4 A#ousti#
Neuroma• Bom-erg test• 9A&
Bom-erg test
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*ertigoOtogeni3
Neurogeni3
!" Type
%"Dire#tion
Botatorydire#tional'ori@ontal
Botatory
Non rotational
Hori@ontal,rotatory
s#otoma
I" *BTI6O
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a"Po&'t'onchange&
(" Ga't.'&t)r(anc
e
c" A)tono)+.*&1)nct'on
." Other&&*+-to+&
In2)ence (*hea.-o&'t'on3(o.*
Rarel*
Al4a*&
T'nn't)&,hear'ng lo&&De5c'tne)rolog'c 1ocal
678
In2)ence (*nec9 +ot'on
o1ten
Rarel*
I+-a're.con&c'o)&ne&&De5c'tne)rolog'c1ocal 6:8
II" &'ysi#al Diagnosis
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a"D'rect'on In.'rect'on B'.'rect'on-" Type Hori@ontal or
rotatory'ori@ontal
Botatoryverti3al, do5n-eat, up -eat
#" ye $:ation -lo#3ing Non -lo#3ingd" Nystagmus
positionalBepeat DiJ#ult asy repeated
e" ye
tra#3ing
sinusoid =a##adi#/ata:i#
0" alory Unilateral5ea3ness
9ilateral5ea3ness
III" Nystagmus e:amination
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a" Bom-erg test Mata ter-u3a Mata tertutup
Normala-normal
A-normalA-normal
-" Griting test Deviasi a-normal Ata:ia / 5ave
#" Ata:ia none o0ten
d" Finger to $ngertest
Normal A-normal
e" &ast pointingtest
A-normal -ot''ands
A-normal side o0lesion
0" =tepping Deviation o0 sideo0 lesion
rrati# deviation
g" Gal3ing eye #losed T'ere aredeviation
ye #losed andopen are deviation
I*" *esti-ulo spinal e:amination
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Depend upon t'e su-type and #auseidenti$ed
• =upporti0 • =imptomati#
• ausati0
• Operati0
Treatment o0 *ertigo
I = t ti T t t
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I" =ymptomati# Treatment
Anti 'istamine
Dymen 'ydrinate ( : 2.mg/day
innari@ine ( : %2mg/day
a+entry -lo#3er
Flunari@ine ( : 2+ !.mg/dayHistamini#
9eta'istine ;merislon< ( : Kmg/day
Fenotia@ine'lorproma@ine ( : %2mg/day
Meto#lopramide
&rimperan ( : !.mg/day
Treatment
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ausative Treatment
Anti platelet agregationOperati0 Tumor =pondylosis servi3alis
pilepsi &'enitoin ar-ama@epin
Migrain
rgotamine Flunari@ine
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Be'a-ilitati0 Treatment
+ Metode 9randt+Daro
+ 6ait e:er#ise
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ZI-MING W, ET AL. THE EFFECT OF BETAHISTINE MESYLATE AS A TREATMENT TO VERTIGO INDUCED BY INNER
EAR ISCHEMIA. CHINESE SCIENTIFIC JOURNAL OF HEARING & SPEECH REHABILITATION 2!
T"# E$$#% '$ B#(")*)+# M#*(#(* ( T#(/#+ ' V#)0' I+1%#13 I++# E( I*%"#/)(
O34 )
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O34#%)5#
T' '3*#5# "# #$$#%* '$ 3#(")*)+# /#*(# (* ( #(/#+ '
3#+)0+ 6'*))'+( 6('7*/( 5#)0' 8BPPV9, 6'*#)' %)%()'+
)*%"#/)( 8PCI9, /)0()+'* 5#)0' 8MV9 (+1 ##+(0# 3#+)0+6('7*/( 5#)0' (+1 ' *1 "# %(*( #()'+*")6* '$ 1'*(0#*
3#:##+ 3#(")*)+# /#*(# ; /0 &
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6rouping o0 patients
&arameter Hig' stimulating rate o0 auditory -rainstemresponse ;A9B<
Di@@iness 'andi#ap inventory ;DHI<
A9B DHI -e evaluated #ompared -e0ore a0teradminstration o0 -eta'istine mesylate
Total pasien nC P.
9&&* &I M*(. pasien (. pasien (. pasien
MB= 1 mgMB= !% mgMB= 1 mgMB= !% mgMB= 1 mgMB= !% mg!2 patients!2 patients!2 patients!2 patients!2 patients!2 patients
i+ming G, et al" T'e e#t o0 9eta'istine Mesylate as a Treatment to *ertigo Indu#ed -yInner ar Is#'emia" 'inese =#ienti$# ournal o0 Hearing =pee#' B'a-ilitation %..
P B ") ) M
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pQ.".! pQ.".!pQ.".2
#*)/6(+ E$)(*) 1)+4(+ '#" #1( 06 3() ; /0 /(6+
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nCP.
&eere
+'l.
i+ming G,et al" T'e ee#t o0 -eta'istine mesylate as a treatment to vertigo indu#ed -y inner ear is#'emia" %..
#*)/6(+ E$)(*) 1)+4(+ '#" #1( 06 3() ; /0 /(6+
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9eta'istine Mesylate !%mg, ( : se'ari ditoleransi dengan-ai3 ole' pasien *ertigo dan Di@@iness"
Dari #"#;
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• *ertigo is pu-li# 'ealt' pro-lemespe#ially in t'e elderly
• Need anamnesis and e:aminationas 5ell as t'e etiology o0 vertigo
• Treatment depends on t'e su-type
and #ause
on#lusion
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