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VERTIGO. KULIAH BLOK 15 Neuromuskuloskeletal FK-UMY. PENDAHULUAN. DEFINISI: Vertigo adalah perasaan penderita merasa dirinya atau dunia berputar ETIOLOGI Otologi: 24-61% kasus Benigna Paroxysmal Positional Vertigo (BPPV) Meniere Desease Parese N VIII Uni/bilateral Otitis Media.

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VERTIGO


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    1. VERTIGO KULIAH BLOK 15 Neuromuskuloskeletal FK-UMY

    2. PENDAHULUAN • DEFINISI: Vertigo adalah perasaan penderita merasa dirinya atau dunia berputar • ETIOLOGI • Otologi: • 24-61% kasus • Benigna Paroxysmal Positional Vertigo (BPPV) • Meniere Desease • Parese N VIII Uni/bilateral • Otitis Media

    3. 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

    4. 3. Interna: • +/- 33% karena gangguan kardio vaskuler • tekanan darah • Aritmia kordis • Penyakit koroner • Infeksi • < glikemia • Intoksikasi Obat: Nifedipin, Benzodiazepin, Xanax,

    5. 4. Psikiatrik • > 50% kasus • Klinik dan laboratorik : dbn • Depresi • Fobia • Anxietas • Psikosomatis 5. Fisiologik • Lihat dari ketinggian

    6. PATOFISIOLOGI VERTIGO Efektor Reseptor Pengelola data • Mata • Vestibuler • Propioseptik Saraf Pusat • Otot skelet • Mata • Leher • Badan • Anggota gerak

    7. Receptor Central Nervous System Sign & Simptom Cerebral cortex NAUSEA Dizziness Somnolence Headache Depression Performance- decrement Hypothalamus Retina Vestibular Cerebellum Pituitary Increased Secretion of ADH, ACTH, GH, PRL Motion stimuli Vestibular Nuclei Vestibular Apparatus Autonomic centres CTZ SWEATING PALLOR Decreased Gastric motility, Cardiovasculer & Inspiratory changes Somatosensory Receptors Vomiting centre VOMITING

    8. 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

    9. ABNORMAL PROCESSING Vestibular system Visus Propiocepsis Sensory information =abnormal =Excesive =Discordant information stimuli CENTRA = unknown patern NEUROVEG. CENTRA ALARM WARNING Oculomotor centra: NISTAGMUS Muscles : DEVIATION CORTEX BECOMES CONSCIOUS AFFECTIVE COMPONENT VERTIGO

    10. Head Acceleration Head angular Velocity Endolymph Displacement Cupular Angle Cilia Bending Receptor Cell Potential Synaptic Action Generator Potential Primay Afferent Action Potentials Ket: CNS: Central Nervous System VOR: Vestibulo Ocular Reflex CNS Perception Posture VOR

    11. DIAGNOSIS VERTIGO ANAMNESIS SERANGAN AKUT LABIRINTITIS KRONIS BERULANG (-) TD. TELINGA TD. TELINGA (-) (+) (+) (-) • N MA • T. SEREB. PONTIN POSISI BERUBAH • OTITIS • MENIERE • N.MA (-) EXHAUSTION NEUROSIS (-) (+) • Co R • A SCL • Obat • > Ventilasi • Trauma Cervical Osteofit Cervical

    12. PEMERIKSAAN NEUROLOGIS: • Kesadaran • Nn. Craniales • Motorik • Sensorik • serebelum

    13. 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

    14. 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: • Puncak tunggal tanpa pemisahan gel. IV dan V • Pemisahan gelombang IV dan V dimana IV lebih pendek dari V • Pemisahan gelombang IV dan V dimana IV lebih tinggi dari V • Gelombang IV naik di atas gel V • Gelombang V naik diatas gel IV • Gelombang terpisah sama tinggi

    15. DIFERENSIAL DIAGNOSIS Beda Vertigo Neurogenik, Otogenik atau Psikogenik

    16. BEDA VERTIGO PSIKOGENIK DAN NEUROGENIK

    17. PENGOBATAN • Pengobatan vertigo neurogenik menyangkut: • tindakan suportif, • terapi simptomatik • Terapi kausatif • Tindakan operasi

    18. Secara garis besar terapi dibagi dalam: • Fase Akut • Anti kolinergik • Sulfas Atropin : 0,4 mg/im • Scopolamin : 0,6 mg IV bisa diulang tiap 3 jam • Simpatomimetika • Epidame 1,5 mg IV bisa diulang tiap 30 menit • Menghambat aktivitas nukleus vestibuler • Golongan antihistamin Golongan ini, yang menghambat aktivitas nukleus vestibularis adalah : • Diphenhidramin: 1,5 mg/im/oral bisa diulang tiap 2 jam • Dimenhidrinat: 50-100 mg/ 6 jam • Flunarizin

    19. Sedatif • Phenobarbital: 15-30 mg/ 6 jam • Diazepam: 5-10 mg • Chlorpromazin (CPZ): 25 mg • Terapi Kausalis • Oklusi: • Anti platelet agregasi • Vasodilator • Flunarizin • Epilepsi: • Phenitoin • Carbamazepin • Migren: • Ergotamin • Flunarizin

    20. Terapi Operatif • Tumor • Spondilosis servicalis • Impresi basiler

    21. TERIMA KASIH