Diagnosis, Pathophysiology and Management of Vertigo

8/18/2019 Diagnosis, Pathophysiology and Management of Vertigo

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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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Diagnosis, Pathophysiology and Management of Vertigo