Gangguan Keseimbangan Perspektif Neurologi
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Transcript of Gangguan Keseimbangan Perspektif Neurologi
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