dr ss vertigo pin nyeri nyeri kepala dan vertigo surabaya 2006

8/13/2019 DR SS Vertigo PIN Nyeri Nyeri Kepala Dan Vertigo Surabaya 2006

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INTRODUCTION

Vertigo:

Common chief complaint

Symptom of multiple diseases

40% all American for Dizziness


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Causes

of

vertigo

A. General medical C. Otological

1. Haematological 1. Menieres disease

Anaemia, Hyperviscosity, Miscellaneous 2. Post-traumatic syndrome

2. Cardiovascular 3. Positional nystagmus

Postural hypotension 4. Vestibular neuronitis

Carotid sinus syndrome 5. Infection

Dysrhythmia 6. Otosclerosis and Pagets disease

Mechanical dysfunction 7. Vascular accidents

3. Metabolic 8. Tumours

Hypoglycaemia 9. Auto-immune disorders

Hyperventilation 10. Drug intoxication

B. Neurological D. Miscellaneous

1. Supratentorial 1. Ocular

Epilepsy, Syncope, Psychogenic 2. Cervical

2. Infratentorial 3. Multisensory dizziness syndrome

Multiple sclerosis, Ischaemia

Infective disorders

Degenerative disorders

TumoursForamen magnum abnormalities


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DIFFERENTIAL DIAGNOSIS

1. Vertigo Dizzy

Vomitus

Disequilibrium

3. Epilepsy:

Aura

Unconsciousness

EEG

Head CT Scan

2. Syncope Absence

Light headaches

Nausea

Visual disturbances Unconsciousness

Low blood pressure

Postural Hypotension

ECG deviation

< Doppler


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DIFFERENTIAL

DIAGNOSIS


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The Type of Vertigo

Central

Peripheral

Mixed type

Gold Standard?

Anamnesis Observation

Diagnosis


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DIAGNOSIS OF VERTIGO

AnamnesisTherapy (+)

Peripheral > Central

CentralRisk Factors


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ALGORITHM to DIAGNOSE AND MANAGE OF VERTIGO

Full history and examination

MedicalInvestigation

Neuro-otologicinvertigation

NeurologicInvestigation

Central

Vertigo

Peripheral

vertigo

Medical

Treatment of

Acute Attack

Medical

Treatment of

Chronic Recurrent Vertigo

Physical exercise

Regimens of maneuvers

Psychological support

Vestibular sedatives

FailureSurgery (?)

(+ / - )

Mixed Type

Vertigo

Supportive

Symptomatic

Causative


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Differential Diagnosis andManagement for the Chiropractor,

Peripheral or Central Causes?

Peripheral

Labyrinth or vestibular

nerve dysfunction

Recurrent

Nystagmus-horizontal

Position change

Moderate to severe

vertigo

Central

Cerebellum or brain

stem dysfunction

Continuous

Nystagmus-vertical

Non-positional

Mild vertigo


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Schimp D. A diagnostic algorithm forthe dizzy patient Chiropractic

Vertigo

Episodic

positional

Episodic

Non-positional

Non-episodic

Non-positional

DIAGNOSTIC ALGORITHM FOR THE DIZZI PATIENT

1 2 3


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Episodic

positional

Benign

positionalCervicogenic

Vertebobasilar

ischemia

gradualsudden sudden

Fades 30-60

secondspersists progression

1


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Episodic non-positional

Menieres Perilymph fistula

Non-episodic

Non-positional vertigo

Labyrinthitis Acoustic neuroma Cerebral hemorrhage

2

3


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BPPV Benign Recurrent of Vertigo

BPPV: Acute Vertigo

Benign

Movement / provocation of head Horizontal nystagmus

Benign Recurrent of Vertigo

Acute

Several minutes hours

Static of disequilibrium


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Diagram - interaction of

autonomic, psychological, and vestibular symptoms


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EXAMINATION

Blood laboratorynot specific

Neurological examination

Radiology examination BERA (Brainstem Evoked

Response Auditory)

Audiometry ?


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NEUROLOGICAL EXAMINATION

Within normal limits

Anamnesis >> important

Acute vertigoemergency case Peripheral vertigoacute onset, horizontal nystagmus

Central vertigoRisk factors(?), vertical / rotational

nystagmus


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NEUROLOGICAL EXAMINATION (cont)

Provocation test to increase vertigo symptoms :

Hallpike Dick maneuver

Examination of:

1. Consciousness

2. Cranial Nerve

3. Motoric

4. Sensory

5. Cerebellar functions


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SPECIFIC EXAMINATION FOR VERTIGO

Heart rate and rhythm of the heart

Palpation on the Carotid artery

Auscultation of the Carotid artery

Romberg test

Tandem gait


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ANOTHER STIMULATION FOR VERTIGO

Orthostatic hypotension Valsava maneuver

Rotational of the head

Nylen Barani Test

Hallpike-Dick Maneuver Caloric test

Neuro-ophtalmology examination

Otology Examination

Head Ct Scan / MRI

Audiometry

BERA


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Hallpike Dick Maneuver


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TREATMENT

Supportive

Symptomatic

Causative Operative

Onset of Therapy:

Acute

Chronic


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Acute Phase

1. Anti Cholinergic

Sulfas atropine 0,4 mg im

Scopolamine 0,5 mg i.v; repeated every 3 hours

2. Sympathycomimetic

Epidame 1,5 mg i.v repeated every 30 minutes


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Inhibition of Vestibular Nucleus

1. Anti histamine :

Diphenhidramine 1,5 mg im/ p.o repeated every 2 hours

Dimenhidrinate 50-100 mg every 8 hours

Flunarizine

2. Sedative :

Phenobarbital 10-30 mg/ 6 hours Diazepam 5-10 mg

Chlorpromazine (CPZ) 25 mg


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CAUSATIVE THERAPHY

1. Vertebrobasilar insufficiency Anti platelet aggregation

Vasodilators

Flunarizine

2. Epilepsy Phenitoine

Carbamazepine

3. Migraine Ergotamine

Flunarizine


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OPERATIVE THERAPHY

Tumors

Cervical spondylosis

Basilar impression


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CONCLUSION

Incidence of vertigo : 10-15%

Uncomfortable but not fatal

Differential diagnosis of Central and peripheralvertigo treatment

Maneuver to precipitate vertigo

Recurrent must be prevent Etiology and symptomatic treatment


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dr ss vertigo pin nyeri nyeri kepala dan vertigo surabaya 2006

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