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Vertigo
Dr. Pagan Pambudi, Sp.S
Introduction
• After headache, vertigo and dizziness are among
the most frequent presenting symptoms, not only
in neurology.
• According to a survey of over 30,000 persons, the
prevalence of vertigo as a function of age is around
17%; it rises to 39% in those over 80 years of age
VOR
Definition
• Vertigo is considered either an unpleasant
disturbance of spatial orientation or the illusory
perception of a movement of the body (spinning
and wobbling) and/or of the surroundings.
Type of Vertigo
• Non vestibular
• Vestibular
• Central
• Peripheral
Peripheral vs Central
Peripheral
• Latency 15-40”
• Nystagmus horizontal
rotatoar
• Duration of Attack 5 –
40”
• Nausea and vomiting
rare at head positioning
maneuver
• Neurological symptom -
Central
• No latency or 1 – 5”
• Vertical torsional
nystagmus
• > 40”
• Nausea vomiting
frequent
• Neurological symptom +
Vertigo perifer
• BPPV
• Meniere disease
• Vestibular neuritis
Patofisologi
Patofisiologi BPPV
Patofisologi Meniere Disease
Patofisologi Vestibular neuritis
DD Vertigo perifer
BPPV Meniere Vest neuritis
Positional vertigo yes Yes yes
Attack seconds days days
Nausea, Vomit + + +++
Age Old Old Young
Severity of Vertigo Mild - Moderate Mild - Moderate Moderate -severe
Hearing Loss - ++ -
Dx
• History
• Physical Exam
• Common neurological exam
• Vestibular system exam
• Audiometry
DD
• Other peripheral vertigo
• Central Vertigo
• Non vestibular vertigo
• Migrainous Vertigo
Treatment
• BPPV
• Otolith repositioning
• Eppley, brandt Daroff, Semont manuver
• Meniere
• Betahistin
• HCt
• Vestibular Neuritis
• Corticosteroids
Pragmatic/Symptomatic
• Dimenhidrinat
• Betahistine
• Flunarizine
• Atropin
• Antiemetics
BD Manuver
THANKS

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Vertigo.pptx