Melke J TumboimbelaBagian/SMF Neurologi

FK UNSRAT-RSU BLU PROF DR R D KANDOUManado

PENDAHULUAN

PENDAHULUAN

Visual input

Proprioceptual

input

Vestibular input

labyrinths

EQUILIBRIUM

PENDAHULUAN

SISTEM VESTIBULAR

ANATOMI

Anatomi sistem vestibular perifer dalam hubungannya dengan telinga

ANATOMI

Central vestibular pathwaysThe afferents from the vestibular labyrinth project to each of the vestibular nuclei in the rostral medulla and the caudal pons. Afferents from the ampullae of the SCC project to the superior vestibular nucleus (SVN) and rostral portion of the medial vestibular nucleus (MVN).Afferents from the maculae of the utricle and saccule terminate in the lateral vestibular nucleus (LVN). Some afferents from the macula of the saccule project to the inferior vestibular nucleus (IVN).

MLF = medial longitudinal fasciculus.

Essential neuroscience / Allan Siegel, Hreday N. Sapru ; 2nd ed.

ANATOMI

Gejala Gangguan Vestibular

Disfungsi Vestibular

GANGGUAN KLINIS SISTEM VESTIBULAR

NYSTAGMUS

NYSTAGMUS

NYSTAGMUS

MOTION SICKNESS

INFLAMASI LABIRIN VESTIBULAR

PENYAKIT MENIERE

VERTIGO DAN DIZZINESS

VERTIGO DAN DIZZINESS

VERTIGO

Vertigo perifer sentral

Durasi & keparahan

Intermiten

berat

Konstan

Biasanya ringan

Nystagmus Selalu ada

Satu arah

Tidak pernah vertikal

Dapat tidak ada

Uni/bidireksional

Mungkin vertikal

Temuan lain PekakTanda batang otak

Ada

Tidak ada

Jarang ada

ada

MEMBEDAKAN VERTIGO SENTRAL DAN PERIFER

PERBEDAAN NYSTAGMUS POSISIONAL SENTRAL & PERIFER

PERIFER SENTRALLatensi 3 – 10 detik -Durasi < 1 menit > 1 menitFatiq Ya dengan

pengulanganTidak

Gejala penyerta Mual, muntah Diplopia, disartria

Nystagmus vertikal

Absen Bisa ada

Nystagmus rotatoar

Umum Tidak umum

PENYEBAB

TOKSISITAS OBAT

PENYEBAB LAIN

VERTIGO PERIFER

BENIGN PAROXYSMAL POSITIONING VERTIGO

BENIGN PAROXYSMAL POSITIONING VERTIGO

VESTIBULAR NEURITIS

PENYAKIT MENIERE

VESTIBULAR PAROKSISMIA

VESTIBULOPATI BILATERAL

FISTULA PERILIMF

VERTIGO SENTRAL

BASILAR/VESTIBULAR MIGRAINE

IN CASE OF VERTIGO

No sponteous nystagmus Sponteous nystagmus

Posture and balance control negative Posture and balance control positive

Nausea vomiting

Sweating, tachycardia Nausea, vomiting, sweating, anxiety

GI disorder Chest pain Anxiety „Harmonic” vestibular sy

„Dysharmonic” vestibular sy

Internal medicine

Angina, MI Loss of hearing, tinnitus

Numbness,

double vision, dysarthria

Cardiology Psychiatry Vestibular neuronitis,

Meniére disease

Brainstem infarct

Otology Neurology

1. Is this vertigo?

2. Is this central or peripheral?

3. History

4. Exam- focus on CN and coordination,focal neurological findings, Dix-Hallpike

Duration of vertigo

Time Peripheral Central

Seconds BPPV VB-TIA, aura of epilepsy

Minutes perilymph fistula VB-TIA, aura of migraine

(Half) hours Meniére disease basilar migraine

Days vestibular neuronitis labyrinthitis

VB stroke

Weeks, Month acustic neurinoma, drug toxicity

multiple sclerosis cerebellar

degenerations