Sudden vertigo and nausea vomiting associated with a

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Sudden vertigo and nausea Vomiting associated with a headache Inability to stand Nystagmus, nuchal rigidity, facial paralysis, ataxia, dysrythmia, small reactive pupils Hx of HTN in 2/3 of patients
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PEMERIKSAAN
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PEMERIKSAAN NEUROLOGIS: Kesadaran Nn. Craniales Motorik Sensorik serebelum
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PEMERIKSAAN KHUSUS Heart rate + irama Palpase a. Carotis Auscultasi bising a. Carotis Romberg test Tandem gait STIMULASI VERTIGO Hipotensi ortostatik Manuver valsava Putar Kepala Nylen-Barany test Kalori test N. OPH N.OTOL
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Nylen-Barany AKA Dix-Hallpike Patient seated, head turned 45 degrees Patient quickly lays supine Latency period, then horizontal or rotational nystagmus Nystagmus decreases after 10-20 seconds Affected ear is the side head is turned toward when nystagmus and vertigo occurs
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Nylen-Barany Maneuver Dizziness, Hearing Loss, and Tinnitus R.W. Baloh, F.A. Davis Company 1998
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Modified Epley’s Maneuver Patient placed supine with head turned 45 degrees toward the affected ear (30 sec.) Dr. turns head 90 degrees so affected ear is up. (30 sec.) Patient rolls on to side, head looking toward the floor (30 sec.) Patient is lifted into sitting position Procedure is repeated until no nystagmus
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Modified Epley Maneuver Dizziness,Hearing Loss, and Tinnitis R.W. Baloh, F.A. Davis Company 1998
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Dix-Hallpike maneuver (used to diagnose benign paroxysmal positional vertigo). This test consists of a series of two maneuvers: With the patient sitting on the examination table, facing forward, eyes open, the physician turns the patient's head 45 degrees to the right (A). The physician supports the patient's head as the patient lies back quickly from a sitting to supine position, ending with the head hanging 20 degrees off the end of the examination table. The patient remains in this position for 30 seconds (B). Then the patient returns to the upright position and is observed for 30 seconds. Next, the maneuver is repeated with the patient's head turned to the left. A positive test is indicated if any of these maneuvers provide vertigo with or without nystagmus.
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PENATALAKSANAAN
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PENGOBATAN Pengobatan vertigo neurogenik menyangkut: tindakan suportif, terapi simptomatik Terapi kausatif Tindakan operasi
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Secara garis besar terapi dibagi dalam: Fase Akut 1. Anti kolinergik Sulfas Atropin : 0,4 mg/im Scopolamin : 0,6 mg IV bisa diulang tiap 3 jam 2. Simpatomimetika Epidame 1,5 mg IV bisa diulang tiap 30 menit 3. Menghambat aktivitas nukleus vestibuler a. Golongan antihistamin Golongan ini, yang menghambat aktivitas nukleus vestibularis adalah : i. Diphenhidramin: 1,5 mg/im/oral bisa diulang tiap 2 jam ii. Dimenhidrinat: 50-100 mg/ 6 jam iii. Flunarizin
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b. Sedatif i. Phenobarbital: 15-30 mg/ 6 jam ii. Diazepam: 5-10 mg iii. Chlorpromazin (CPZ): 25 mg Terapi Kausalis a. Oklusi: Anti platelet agregasi Vasodilator Flunarizin b. Epilepsi: Phenitoin Carbamazepin c. Migren: Ergotamin Flunarizin
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Terapi Operatif a. Tumor b. Spondilosis servicalis Lanjutan……………
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Symptomatic Treatment 1) Ca entry Blocker 2) Antihistamin 3) Anticholinergic 4) Monoaminergic 5) Antidopaminergic 6) Bensodiazepin 7) Histaminic
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