This document discusses vertigo, including its definition, causes, diagnosis, treatment and prognosis. It defines vertigo as abnormal feelings about the surrounding environment like whirling and loss of balance. The causes of vertigo discussed include benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, labyrinthitis, and acoustic neuroma. The diagnosis of vertigo involves taking a medical history, physical examination including neurological tests, and supporting exams. Treatment depends on the cause but may include repositioning maneuvers for BPPV, medications, and vestibular rehabilitation exercises. The prognosis for vertigo depends on its cause and can range from good to poor.

1. VERTIGO
1

2. Definition
Vertere → to turn
Abnormal feelings about surrounding environment feels like whirling and
loss of balance.
2
VERTIGO

3. Vertigo ≠ Dizziness
Dizziness → non specific term, caused by :
Vertigo
Presinkop : fatigue feels caused by hipoperfusion of cerebral
Light-headness
Disequilibrium (whirling or unstable when standing)
3

4. Epidemiology
Of the four types of dizziness, vertigo is the most frequent at
around 54%
4
> 2:1

5. Etiologi
5

6. Pathophysiology
6
1. Overstimulation
2. Sensory Conflict Theory
3. Neural Missmatch Theory
4. Autonomic Theory
5. Sinaptic Theory

7. too much stimulation more than
sensitivity value
Information processing to the
center of body balance organ
Equilibrium Problems
Overstimulation Theory
7
Canalis Semicircularis
Hiperemi

8. Sensoric Conflicts
8

9. 9

10. Neural Mismatch/Sensory Rearrangement
 new movement  old movement patterns(mismatch).
 Adaptation / habituation (+) → rearrangement of old = new
movement patterns (sensory rearrangement)
10

11. Parasympatis Sympatis
MOTION SICKNESS ADAPTED
SYMPATIS
PARASYMPATIS
PARASYMPATIS
SYMPATIS
Normal

12. Sinaptic Theory
 Stress → CRF  → Switch SSS SSP
 Dominasi SSS : vert, pale, nausea.
 Dominasi SSP : vomiting/retching.
 Recurrent stress→ recurrent switch→ pro-gressive
Ca channel closure → Ca inf.  → NT  →
response  → adaptation.
Joesoef AA : Tinjauan Umum mengenai vertigo. Dalam AA. Joesoef, K. Kusumastuti (eds) : Neuro-
Otologi Klinis Vertigo. Airlangga University Press. Surabaya, 2002. p.XIII-XXVIII.
12

13. 13

14. Difference between vertigo
vestibular and non vestibular
14

15. 15

16. Diagnosis
A. Anamnesis
 Dizziness characteristics
 Severity
 the tempo of the attack
 Trigger Factor
 Accompanying Symptoms
 Medication History
 Neurological deficit
16

17. B. Physical Exam
 General Physical Exam
 Cardiovascular system examination
 Neurological examination
17

18. Neurological examination
 Awareness
 Cranial nerves
 Motoric
 Sensoric
 neuro-otology special examination
18

19. 19
neuro-otology
special examination
Nystagmus test
Rhomberg test
Tandem walk gait
Fukuda test
Past Pointing test

20. 20

21. 21

22. 22

23. 23

24. 24

25. 25

26. C. Supporting Exam
- Routine laboratory examination of blood
- CT scan
- MRI
26

27. Treatment
no Type treatment
1 BPPV 1. Medical: betahistine
2. reposition: Epley maneuver, semont procedure,
lampert roll maneuver, brandt daroff method
2 Meniere 1. kausatif: diet rendah garam, diuretik, injeksi steroid
intratimpani, injeksi gentamisin intratimpani
(chemical labirinthectomy), insisi nervus vestibularis,
destruksi labirin
2. Simtomatis: betahistin (48 mg/hari), steroid
prednison (80 mg/hari), vasodilator asam nikotinat
(50-150 mg), antihistamin
27

28. 3 Vestibular neuritis 1. Symptomatic therapy: acute phase
1-3 days: dimenhidrinate 100mg
(antivertigo)
2. Causal therapy: corticosteroids
(methylprednisolone), antivirals
(valacyclovir)
3. 3. Vestibular exercises
4 Labyrinthitis 1. kausatif: antibiotik, pengambilan
jaringan terinfeksi
2. Simtomatis
3. Rehabilitasi vestibuler
5 Neuroma Akustik 1. Observasi
2. Stereotactic radiosurgery
3. Operasi
28

29. General therapy
Symptomatic Therapy
 Antihistamin
- Dimenhidrinat
(Dramamine)
PO 4 x 25-50 mg
- Difhenhidramin
(Benadryl)
PO 4 x 25-50 mg
 Analog Histamin
- Betahistine Mesylate
(Merislon)
3 x 6-12 mg
- Betahistine HCl (Betaserc)
3 x 8mg
 Antagonis Kalsium
- Cinnarizine (Stugerone)
PO 3 x 15-30 mg
 Fenotiazine
- Promethazine (Phenergan)
PO 4 x 12,5-25 mg
- Khlorpromazine (Largactil)
PO 3 x 25 – 50 mg
 Simpatomimetik
- Efedrin
PO 4 x 10mg
 Antikolinergik
- Scopolamine
PO 3 x 0,5 mg
29

30. 30

31. Rehabilitative therapy
31

32.  BrandDaroff Exercise→
32

33. Semont Manuever
1. The patient is asked to sit up straight
2. The head is tilted 450 to the healthy side
3. Quickly moves to the lying position and is held for 5 minutes
4. Observation of nystagmus
5. The patient moves to the lying position on the opposite side without
returning to the sitting position again with the head facing down 33

34. Education
 The family also supports by motivating patients to find the
cause of vertigo and treat it according to the cause.
 Encourage patients to regularly do vestibular exercises.
34

35. Prognosis
Ad vitam : dubia ad bonam
Ad Sanationam : dubia ad malam
Ad Fungsional : dubia ad bonam
35