Vertigo Print 2

8/18/2019 Vertigo Print 2

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UNIVERSITAS PEMBANGUNAN NASIONAL “VETERAN” JAKARTA

LAPORAN KASUS

VERTIGO

Disusun Untuk Memenuhi Sy!t Men"ikuti U#in Ke$nite!n K%inik &i B"in S!'

Rumh Skit Umum De!h Am(!)

Di#ukn Ke$&*

Pem(im(in"* &!+ Nu! Tk&i! Ku!ni Seti)n, S$+S, MS-

Disusun O%eh*

Au%in Dnisy

./.011.023

KEPANITERAAN KLINIK DEPARTEMEN SARA4

4AKULTAS KEDOKTERAN UPN “VETERAN” JAKARTA

RUMA5 SAKIT UMUM DAERA5 AMBARA6A

PERIODE .7 OKTOBER 8 1. NOVEMBER 10.9


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IDENTITAS

Nm * Ny+ M

Usi * /2 thun

Jenis ke%min * Pe!em$un

Sttus m!it% * Menikh

Peke!#n * I(u Rumh Tn""

A"m * Is%m

A%mt * Kem%:k: 1;< Be!"s Ki&u% Be!"s K(+ Sem!n"

Tn""% msuk RS * / N:=em(e! 10.9 $uku% .7+.1

N:+ RM * 0372


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Riwayat Penyakit Dahulu

• Ri)yt ke%uhn se!u$ se(e%umny * &isn"k%

•Ri)yt st!:ke se(e%umny * &isn"k%

• Ri)yt &i(etes me%%itus * &isn"k%

• Ri)yt hi$e!tensi * &isn"k%

• Ri)yt t!um ke$% * &isn"k%

• Ri)yt :$e!si * &isn"k%

• Ri)yt (tuk $i%ek %m * &isn"k%

• Ri)yt "n""un ti&u! &n $e!i%ku * &isn"k%

• Ri)yt skit te%in" * &isn"k%

Riwayat Penyakit Keluarga

• Ri)yt ke%uhn se!u$ * &isn"k%

• Ri)yt st!:ke * &isn"k%

• Ri)yt &i(etes me%%itus * &isn"k%

• Ri)yt hi$e!tensi * &isn"k%

Anamnesis Sistem

• Sistem se!e(!:s$in% * $usin" (e!$ut!

• Sistem k!&i:=sku%e! * ti&k & ke%uhn

• Sistem !es$i!si * ti&k & ke%uhn

• Sistem "st!:intestin% * mu% ?@, munth ?@

• Sistem musku%:ske%et% * ti&k & ke%uhn

• Sistem inte"umentum * ti&k & ke%uhn

• Sistem u!:"enit% * ti&k & ke%uhn

Resume anamnesis

Psien me!s $usin" se$e!ti (e!$ut! hi%n" tim(u% se#k . min""u SMRS+ Ke%uhn tim(u%

men&&k &n hi%n" tim(u%+ Pusin" &i!s mem(ik st isti!ht (e!(!in", &n $usin"

&i!s mem(u!uk st &u&uk tu (e!&i!i+ Te%in" knn (e!&en"un" hi%n" tim(u% &n nye!i

&en"n VAS se#k . min""u SMRS+ Pusin" &i!s mem(e!t se#k 1 h!i SMRS, $sien

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ti&k (is ti&u! &en"n nyenyk+ Psien me!s mu% &n munth yn" hi%n" tim(u% se#k .

min""u SMRS+ Psien ti&k (is (e!&i!i k!en me!s $usin" (e!$ut! &n me!s kn

#tuh, $sien ti&k (is (e!kti=its se$e!ti (is+ Psien $e!nh $e!iks ke &:kte! umum &i

k%inik &n &i(e!ikn :(t untuk < h!i, #ik ke%uhn ti&k mem(ik &%m < h!i, $sien

&is!nkn untuk $e!iks ke !umh skit+ Sete%h minum :(t, ti&k (nyk $e!u(hnte!h&$ ke%uhn $usin"+ Psien ti&k &$t men"in"t nm :(t+ Psien menyn"k%

&ny $n&n"n k(u!, $en"%ihtn "n&, ke%emhn n"":t "e!k, $enu!unn

$en&en"!n, &emm, &n ke#n"+ Psien #u" menyn"k% &ny !s (%, kesemutn,

$enu!unn (e!t (&n, (tuk, $i%ek, skit ten"":!:kn, &n sesk n's+ Bun" i! ke-i% &n

(un" i! (es! ti&k te!&$t ke%uhn+

DISKUSI I

D!i nmnesis &i&$tkn kete!n"n $sien se:!n" $e!em$un (e!usi /2 thun &tn" ke

IGD RSUD Am(!) &en"n ke%uhn $usin" (e!$ut! yn" mem(u!uk st &u&uk tu

(e!&i!i &n mem(ik st (e!(!in", mu% ?@, munth ?@, te%in" knn (e!&en"in" hi%n"

tim(u% ?@ &n nye!i te%in" knn ?@+ Ke%uhn ti&k &ise!ti $en"%ihtn k(u!, $en"%ihtn

"n& &n "n""un $en&en"!n+ Ke%uhn utm yn" &i%mi $sien &%h $usin"

(e!$ut! tu yn" &ise(ut =e!ti":+ Ve!ti": me!u$kn sutu h%usinsi "e!kn %in"kun"n

sekit! se!s (e!$ut! men"e%i%in"i $sien tu $sien se!s (e!$ut! men"e%i%in"i

%in"kun"n sekit! .:(tn, te!%%u se&ikit

tu (nyk %i!n &!h ke :tk, k:m$%iksi &!i $enykit met(:%ik &n %in>%in7+

Pt:%:"i "n""un keseim(n"n

D%m k:n&isi %t keseim(n"n (ik sent!% mu$un $e!i'e! yn" ti&k n:!m% tu

&ny "e!kn yn" neh ;(e!%e(ihn, mk ti&k te!#&i $!:ses $en":%hn yn" )#! &n

mun-u% =e!ti":+ Se%in itu te!#&i $u% !es$:n $enyesuin :t:t>:t:t yn" ti&k &ekut,

sehin"" mun-u% "e!kn (n:!m% &!i mt ?nist"mus@, unste&iness;tksi )ktu

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(e!&i!i;(e!#%n &n "e#% %inny+ Se(( $sti men"$ te!#&i "e#% te!se(ut (e%um

&ikethui.0+

Ve!ti": &ise((kn :%eh "n""un keseim(n"n tu(uh yn" men"ki(tkn

keti&k-:-:kn nt! $:sisi tu(uh yn" se(en!ny &en"n $ yn" &i$e!se$si :%eh

susunn s!' $ust+ Te:!i =e!ti":*

.+ Te:!i k:n'%iks sens:!is * !n"sn" &its m(n" 'isi:%:"is kn men"ki(tkn (n#i!

in':!msi &i $ust kesim(n"n, sehin"" menin"ktkn ke"itn SSP, k::!&insi &n

men#%! ke sekit!ny, te!utm s!' :t:n:m, k:!teks &n tim(u% sin&!:m =e!ti":+

1+ Te:!i neural mismatch* !eksi tim(u% ki(t !n"sn" "e!kn yn" se&n" &ih&$i

ti&k sesui &en"n h!$n yn" su&h te!sim$n &i mem:!i &!i $en"%mn "e!k

se(e%umny+ Pen"%mn "e!k &i mem:!i &i -e!e(e%um &n k:!teks -e!e(!i+ Lm

ke%mn kn te!#&i $enyusunn kem(%i $:% "e!kn yn" se&n" &ih&$i sm

&en"n $:% yn" & &i mem:!i+ O!n" men#&i (e!&$tsi+ Mkin (es!

keti&ksesuin $:% "e!kn yn" &i%mi &en"n mem:!i mk mkin he(t

sin&!:m yn" mun-u%+ Mkin %m $!:ses sensory rearrangement mk mkin %m

$u% &$tsi :!n" te!se(ut te!#&i+

hi$:'ise>&!en%in+

Rn"sn"n ke k:!teks %im(ik menim(u%kn "e#% nsiets &n tu &e$!esi+ Bi%

sin&!:m te!se(ut (e!u%n" ki(t !n"sn"n tu %tihn, mk sik%us $e!u(hn

&:minsi s!' sim$tis &n $!sim$tis (e!"ntin te!se(ut #u" (e!u%n" sm$i

sutu ketik te!#&i $e!u(hn sensiti'its !ese$t:! ?hi$:sensiti'@ &n #um%h !ese$t:!

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?&:)n !e"u%ti:n@ se!t $enu!unn in'%uks -%sium+ D%m ke&n ini $sien te!se(ut

te%h men"%mi &$tsi.0+

9+ Te:!i !n"sn" (e!%e(ihn ?:=e!stimu%ti:n@

Te:!i ini (e!&s!kn sumsi (h) !n"sn"n yn" (e!%e(ihn menye((kn

hi$e!emi kn%is semisi!ku%!is sehin"" 'un"siny te!"n""u, ki(tny kn tim(u%

=e!ti":, nist"mus, mu% &n munth+

+ Te:!i sin$s

Me!u$kn $en"em(n"n &!i te:!i se(e%umny yn" menin#u $e!nn

neu!:t!nsmisi &n $e!u(hn>$e!u(hn (i:m:%eku%e! yn" te!#&i $& $!:ses

&$tsi, (e%#! &n &y in"t+

Ve!ti": se-! eti:%:"i &i(e&kn ti$e $e!i'e! &n sent!%+ Ve!ti": $e!i'e! (i% %esi $&

%(i!in &n ne!=us =esti(u%!is se&n"kn sent!% (i% %esi $& (tn" :tk sm$i ke k:!teks+

VERTIGO SENTRA

Penye(( =e!ti": #enis sent!% (isny & "n""un &i (tn" :tk tu &i

se!e(e%um+ Untuk menentukn "n""un &i (tn" :tk, $kh te!&$t "e#% %in yn"

khs mis%ny &i$%:$i, $!estesi, $e!u(hn sensi(i%its &n 'un"si m:t:!ik, !s %emh 7+

Eti:%:"i*

• Vsku%!

• Demie%inissi

• Ne:$%sm

VERTIGO PERI!ER

Ve!ti": =esti(u%! menye((kn nuse &n munth, seti&kny $& )%ny, se!t

ke-en&e!un"n untuk #tuh ke sisi %esi+ Nist"mus yn" menye!tiny men"inn&uksi i%usi

$e!"e!kn %in"kun"n ?0si%:$si@+ Sehin"", $sien memi%ih untukk menutu$ mtny, &nuntuk men"hin&!i i!itsi %e(ih %n#ut $& sistem =esti(u%! &en"n men#" ke$% $&

$:sisi yn" te!'ikssi, &en"n te%in" yn" (n:!m% te!%etk &i("in $%in" ts/+

Eti:%:"i*

.+ Benign Paroxysmal Positional Vertigo ?BPPV@

Benign Paroxysmal Positional Vertigo ?BPPV@ me!u$kn $enye(( utm

=e!ti":+ Onsetny %e(ih se!in" te!#&i $& usi !t>!t 9. thun 7+

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Benign Paroxysmal Positional Vertigo ?BPPV@ &ise((kn :%eh $e!"e!kn :t:%it

&%n kn%is semisi!ku%!is $& te%in" &%m+ 5% ini te!utm kn mem$en"!uhi

kn%is $:ste!i:! &n menye((kn "e#% k%sik t$i ini #u" &$t men"eni kn%is

nte!i:! &n h:!i:nt%+Ot:%imen"n&un" K!ist%>k!ist% ke-i% k%sium k!(:nt yn"

(e!s% &!i ut!iku%us te%in" &%m +Pe!"e!kn &!i :t:%it &istimu%si :%eh $e!u(hn

$:sisi &n menim(u%kn mni'estsi k%inik =e!ti": &n nist"mus+ Benign

Paroxysmal Positional Vertigo ?BPPV@ (isny i&i:$tik t$i &$t #u" &iikuti

t!um ke$%, in'eksi k!:nik te%in", :$e!si &n neu!itis =esti(u%! se(e%umny,

meski$un "e#% Benign Paroxysmal Positional Vertigo ?BPPV@ ti&k te!#&i

(e!thun>thun sete%h e$is:&e+

1+ L(i!initis

Ke%uhn =e!ti":, mu%, ti, tinnitus, $enu!unn $en&en"!n &n nist"mus+

5% ini (e!hu(un"n &en"n in'eksi =i!us;(kte!i $& %(i!in+ Te!#&i $& sekit!

.9F ksus =e!ti": :t:%:"ik+


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'iri()iri Vertig# $eri%er Vertig# sentral*angkitan Vertig# Men&&k Lm(tDera+at Vertig# Be!t Rin"nPangaruh Gerakan Ke$ala >

Ge+ala Ot#n#m >Gangguan Pen&engaran >esi Sistem =esti(u%e! ?te%in"

&%m, s!' $e!i'e!@

Sistem =e!te(!:(si%e! &n

"n""un =sku%! ?:tk,

(tn" :tk, se!e(e%um@

Penye,a, Ve!ti": $:sisi:n%

$!:ksism% #ink ?BPPV@,

$enykit mnie!e, neu!:nitis

=esti(u%e!, %(i!intis,

neu!:m kustik, t!um

iskemik (tn" :tk,

=e!te(!:(si%e! insu'isiensi,

ne:$%sm, mi"!en (si%e!

Ge+ala gangguan SSP Ti&k & Dint!ny *&i$%:$i,

$!estesi, "n""un

sensi(i%its &n 'un"si

m:t:!ik, &is!t!i, "n""un

se!e(e%!

Masa laten /0 &etik Ti&k &

-a,ituasi Ti&k

Be!&s!kn "e#% k%inis, =e!ti": &i("i*

.+ Ve!ti": P!:ksism%

• Ci!i khs*

o Se!n"n men&&k

o Be!%n"sun" (e(e!$ menit tu h!i

o Ge#% men"hi%n" sem$u!n, sutu ketik mun-u% %"i, &n &int!

se!n"n $en&e!it (e(s &!i ke%uhn+

• Be!&s! "e#% $enye!tny &i("i*

o Den"n ke%uhn te%in", tu%i tu te%in" (e!&en"in"*

- Sin&!:m Menie!e

- A!hn:i&itis $:nt:se!e(e%!is

- TIA =e!te(!:(si%e!

- Ke%inn :&:nt:"en

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- Tum:! ':ss $:ste!i:!

o Tn$ ke%uhn te%in"*

- TIA =e!te(!:(si%e!

- E$i%e$si

- Mi"!ine

- Ve!ti": nk

- L(i!in $i-u

o Tim(u%ny &i$en"!uhi :%eh $e!u(hn $:sisi*

- Ve!ti": $:sisi:n% $!:ksism% (eni"n+

1+ Ve!ti": K!:nis

• Ci!i khs*

o Ve!ti": menet$ %m

o Ke%uhn k:nstn ti&k mem(entuk se!n"n>se!n"n kut+

• Be!&s! "e#% $enye!tny &i("i*

o Den"n ke%uhn te%in"*

- OMC

- Tum:! se!e(e%:$:ntin

- Menin"itis TB

- L(i!initis k!:nik+

o Tn$ ke%uhn te%in"

- K:ntusi: se!e(!i

- 5i$:"%ikemi

- Ense'%itis $:ntis

- Ke%inn :ku%e!

- K!&i:=sku%e! &n $sik:%:"is

- P:st t!umtik sin&!:m

- Int:ksiksi

- Ke%inn en&:k!in

o Tim(u%ny &i$en"!uhi :%eh $e!u(hn $:sisi*

- 5i$:tensi :!th:sttik

- Ve!ti": se!=ik%is

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n"su! (e!ku!n" tet$i

ti&k $e!nh (e(s se!n"n+ Be!&s! "e#% $enye!tny &i("i*

•

Den"n ke%uhn te%in"*o Neu!itis N+ VIII

o T!um %(i!in

o Pe!&!hn %(i!in

o 5e!$es H:ste! :tikus+

• Tn$ ke%uhn te%in"

o Neu!itis =esti(u%!is

o Sk%e!:sis mu%ti$e%

o Ok%usi !te!i se!e(e%i in'e!i:! $:ste!i:!

o En-e'%itis =esti(u%!is

o

Sk%e!:sis mu%ti$%eo 5emt:(u%(i+

2,.0

Diagn#sis Sementara

• Di"n:sis k%inis * $usin" (e!$ut! :nset kut, mu%, munth

• Di"n:sis t:$i- * :!"n =esti(u%!is && :!"n n:n =esti(u%!is

• Di"n:sis eti:%:"i * =e!ti": $e!i'e! && =e!ti": sent!%

o Ve!ti": $e!i'e!*

Ot:"enik

− Otitis Me&i

− Benign Paroxysmal Positional Vertigo

?BPPV@

− Ménière’s Disease ? Endolymphatic

Hydrops

Neu!:"enik

− Gn""un se!e(!:=sku%!

− Gn""un =isus

− Mu%ti$e% sk%e!:sis

− Ve!ti": se!=ik%

Inte!n

− In'eksi

− 5i$:;hi$e!tensi

− A!itmi k:!&is

− Penykit k:!:ne!

− 5i$:"%ikemi

− Int:ksiksi :(t* ni'e&i$in,

(en:&ie$in, n

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Psikit!ik

− K%inik &n %(:!t:!ik &(n

− De$!esi

− 4:(i

−

Aniets− Psik:s:mtis

Lin>%in

− C!ies &entis

o Ve!ti": sent!%

Ce&e! ke$%

Ne:$%sm

Vsku%!

Sin&!:m se!e(e%%um

Sin&!:m =e!te(!:(si%e!

PEMERIKSAAN !ISIK

Sttus "ene!%is * Bik, "ii (ik

Ke&n umum * GCS E/V9M

Kes&!n * C:m$:s mentis

Tn& =it% * Teknn &!h .00;30 mm5" Pe!n$sn 10;menit

N&i 3;menit Suhu ;>@, sk%e! ikte!ik ?>;>@

Te%in" * Bentuk n:!m%, simet!is+

5i&un" * Bentuk n:!m%, ti&k & se$tum &e=isi

Mu%ut * Bi(i! simet!is, '!in" ti&k hi$e!emis, t:nsi% T.>T. tenn",

Lehe! * Simet!is, ti&k & $em(es!n ke%en#! ti!:i&, ti&k & &e=isi t!ke, ti&k te!( $em(es!n ke%en#! "eth (enin"

Th:!ks * Simet!is, !et!ksi su$!ste!n% ?>@

Pu%m: * I th:!ks simet!is &en"n eks$nsi (ik

P '!emitus tksti% knnki!i, eks$nsi &in&in" &&

P s:n:! &i se%u!uh %$n" $!u

A =esiku%e! ?;@ , !:nkhi ?>;>@, )heein" ?>;>@

C:! * I Ti&k tm$k iktus -:!&is

P iktus -:!&is ti&k te!(

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P Bts ts ICS III %ine $!ste!n% sinist!

Bts ki!i ICS VI %ine mi&-%=i-u% sinist!

Bts knn ICS IV %ine ste!n%is &et!+

A BJ I &n II !e"u%!, G%%:$ ?>;>@, mu!mu! ?>;>@

A(&:men * I &t!

A (isin" usus ?@

P &in&in" $e!ut su$e%, tu!":! ku%it %e(ih (ik+, he$! &n %ien ti&k

te!(

P tim$ni

Ekst!emits * Ak!% hn"t, CRT 1 &etik, e&em tun"ki ?>;>@, sin:sis ?>@

Status Neur#l#gis

o Sik$ tu(uh * n:!m%

o Ge!kn (n:!m% * ti&k &

o Ke$% * $usin" (e!$ut!

o S!' :tk

Ner"us Pemeriksaan Kanan KiriN . I Dy $en"hi&u N NN . II Dy $en"%ihtn N N

Pen"%ihtn )!n N N

L$n" $n&n" N N

N . III Pt:sis N N Ge!kn mt ke me&i% N N

Ge!kn mt ke ts N N Ge!kn mt ke ()h N N

Uku!n $u$i% < mm < mm

Re'%eks -hy %n"sun" N N

Re'%eks -hy k:nsensui% N N

St!(ismus &i=e!"en 8 8

IV Ge!kn mt ke %te!% ()h N NSt!(ismus k:n=e!"en N N

Men""i"it N N

Mem(uk mu%ut N N

V Sensi(i%its muk N N

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Re'%eks k:!ne N N

VI T!ismus 8 8 Ge!kn mt ke %te!% N N

St!(ismus k:n=e!"en N N

N VII Ke&i$n mt N NLi$tn ns:%(i% N N

Su&ut mu%ut N N

Men"e!utkn &hi N N

Menutu$ mt N N

Me!in"is N N

Men""em(un"kn $i$i N N

Dy ke-$ ki&h 1;< Ti&k &i%kukn

$eme!iksn

N. VIII Men&en"! su! (e!(isik N NMen&en"! &etik !%:#i N N

Tes Rinne Ti&k &i%kukn

$eme!iksn

Tes S)(-h Ti&k &i%kukn

$eme!iksn

Tes 6e(e! Ti&k &i%kukn

$eme!iksn

N. I/ A!kus '!in" NDy ke-$ %i&h .;< (e%kn" Ti&k &i%kukn

$eme!iksn

Re'%eks munth Ti&k &i%kukn

$eme!iksn

Te!se&k Ti&k &i%kukn

$eme!iksn

N. / Denyut n&i 3A!kus '!in" N

Be!su! NMene%n Ti&k &

ke%inn

N. /I Mem%in"kn ke$% NSik$ (hu N

Men"n"kt (hu N

T!:'i :t:t (hu Eut!:'i

N. /II Sik$ %i&h Simet!isMen#u%u!kn %i&h N

T!:'i :t:t %i&h Eut!:'i4siku%si %i&h >

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Lehe! * kku %ehe! ?>@

Ekst!emits * &%m (ts n:!m%

Sensi(i%its * msih &%m (ts n:!m%

Ve"etti=e * &%m (ts n:!m%

Pemeriksaan tam,ahan

Nist"mus ;

Dismet!i >

R:m(e!" test

Ste$$in" test

!hermitte’s test ;tes &ist!ksi >;>

Psien &en"n =e!ti": $e!i'e! memi%iki "n""un keseim(n"n nmun msih &$t

(e!#%n, se&n"kn $sien &en"n =e!ti": sent!% memi%iki inst(i%its yn" $!h &n

se!in"k%i ti&k &$t (e!#%n+ 6%u$un Rom"erg’s sign k:nsisten &en"n ms%h

=esti(u%! tu $!:$i:se$ti', h% ini ti&k &$t &i"unkn &%m men&i"n:sis =e!ti":+ P&

se(uh stu&i, hny .7F sensiti=e untuk "n""un =esti(u%! &n ti&k (e!hu(un"n &en"n

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$enye(( yn" %e(ih se!ius &!i di##iness $ ti&k hny te!(ts $& =e!ti":@ mis%ny drug

related %ertigo& sei#ure& arrhythmia& atau cere"ro%ascular e%ent'

Pen&e!it (e!&i!i &en"n ke&u kki &i!$tkn, mu%>mu% &en"n ke&u mt

te!(uk kemu&in te!tutu$+ Bi!kn $& $:sisi &emikin se%m 10>.0 m";&%

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Gluk#sa 0 +am PP 30 .10 m";&%SGOT . 0>90 m";&%

Kreatinin 0,7 0,/9>0,29 m";&%Asam Urat 1,0 1>2 m";&%'h#lester#l .


17/25

Peme!iksn 'isik &ny nist"mus &n & ti&kny "e#% yn" (e!hu(un"n &en"n

"n""un se!e(e%%um mis%ny &ismet!i &n (n:!m%its ne!=us k!ni%es mis%ny

:$ht%m:$%e"i, &i$%:$i tu &is!t!i, se!t $& $eme!iksn 'isik #u" &itemukn !hermitte

test ?>@+

P& $eme!iksn #u" &i&$tkn sistem m:t:!ik &%m (ts n:!m% sehin"" me%emhkn

ke !h =e!ti": sent!%+ Tes !:m(e!" ?@, ste$$in" test ?@, "n""un $en&en"!n?>@, &n &i

h%%$ike mneu=e! ?@ $& st ke&n $sien mem(ik mk hsi% ini men&ukun" ke

!h =e!ti": $e!i'e!+

Pe!(e&n =e!ti": sent!% &n $e!i'e!*

Kus Mu% &n

munth

Atksi Tu%i Ge#%

neu!:%:"is

K:m$enssi

Vertig# $eri%er Be!t J!n" Se!in" J!n" Ce$tVertig# Sentral Se&n" Se!in" J!n" Se!in" Lm(t?Dikuti$ &!i Et:n &n R:%n&@

Tan&a &an Ge+ala Vertig# Peri%er Psien Vertig# Sentral2. Serangan Inte!miten Inte!miten K:nstn0. Pusing ,er$utar 5e(t 5e(t Ti&k te!%%u he(t

?Me%yn", hi%n"

keseim(n"n@

3. Mual muntah 5e(t 5e(t Rin"n4. Nistagmus Se%%u & A& A&;ti&k &5. 'iri Nistagmus Ti&k $e!nh =e!tik% 5:!i:nt% Se!in" =e!tik%6.Kurang $en&engaran 1

tinitus

Se!in" & A& J!n" &

7. Tan&a esi ,atang

#tak

Ti&k & Ti&k & A&

8. Disartria Ti&k & Ti&k & A&9. De%ek Visual Ti&k & Ti&k & A&2:. Di$l#$ia Ti&k & Ti&k & A&22. Dr#$ atta)k Ti&k & Ti&k & A&20. Ataksia Ti&k & Ti&k & A&23. Gaya ,er+alan Lm(t, te"k &n

(e!hti>hti

Lm(t, te"k

&n (e!hti>

hti

Be!"e!k

menyim$n" ke stu

!h, tksik

24. Gerakan Pen)etus Ge!kn ke$% Ge!kn

ke$%

Ge!kn :(#ek =isu%

16


18/25

5mi&,100#m

Nistagmus ?V;5@ ?5@ ?5@ ?5@ J!n", ke-u%i st&ny $e!u(hn

$:sisi

Penurunan$en&engaran

>

K&n"

Tinnitus > K&n"

Mual

Muntah

ain(lain Gi"i (e!%u(n"Ce&e! ke$%

Ri)yt $usin"

(e!$ut!

Nye!i te%in"Senssi te%in"

$enuh

In'eksi (kte!i;=i!us In'eksi =i!us R+ mi"!ineM(uk $e!#%nn

R+ ke%u!"

Diagn#sis Akhir

Di"n:sis k%inik * Sin&!:m =e!ti": $e!i'e!

Di"n:sis t:$i- * O!"n =esti(u%!is

Di"n:sis eti:%:"i- *

• Ot:"enik ?Otitis Me&i Akut@• Penyem$itn ':!men inte!=e!te(!%is

Penatalaksanaan

4!mk:%:"i *

• In#eksi $i!-etm 1 < "!m

Pi!-etm &i"unkn untuk $& %e=e% neu!:n% (e!iktn &en"n ke$% $:%!

$h:s$h:%i$i& mem(!n, mem$e!(iki '%ui&its mem(!n se%, mem$e!(iki

neu!:t!nmisi, menstimu%si &eny%te kinse yn" men"kt%is k:n=e!si ADP

men#&i ATP+

Menin"ktkn ene!"i ?ATP@ :tk, menin"ktkn kti'its adenylat (inase ?AK@ yn"

me!u$kn kun-i met(:%isme ene!"i &imn men"u(h ADP men#&i ATP &n AMP,

menin"ktkn sintesis &n $e!tuk!n -yt:-h!:me (9 yn" me!u$kn k:m$:nen

kun-i &%m !nti t!ns$:!t e%ekt!:n &imn ene!"i ATP &i$!:&uksi &i mit:k:n&!i

?Jmes, 100/@+ Pi!-etm #u" &i"unkn untuk $e!(ikn &e'isit neu!:%:"i

khususny ke%emhn m:t:!ik &n kemm$un (i-! $& ksus>ksus -e!e(!%

17


19/25

iskemi, &n #u" &$t men"u!n"i se=e!its tu kemun-u%n $:st

t!umtik;-:n-ussi:n sin&!:m+ Pi!-etm mem$en"!uhi kti'its :tk me%%ui

(e!("i meknisme nt! %in *

.+ Me!n"sn" t!nsmisi neu!:n &i :tk+

1+ Me!n"sn" met(:%imse :tk+


20/25

C%:(m me!u$kn ":%:n"n (en:&ie$ine yn" (eke!# (e!&s!kn $:tensi%

inhi(isi neu!:n &en"n sm "m> min:(uti!t ?GABA@ se("i me&it:!+

K%:(m memi%iki e'ek ntik:n=u%si, nsi:%itik, se&ti=e, &n !e%kssi :t:t+

Pem(e!in :(t ini &iin&iksikn untuk men"tsi siets & $sik:neu!:ti yn"

&ise!ti nsiets+

• P+O Me!ti": < . t(

N:n>'!mk:%:"i

• Diet !en&h "!m

o Intke s:&ium &%m #um%h (nyk menye((kn !etensi i! $& te%in"

&%m+

o 1>< "!m s:&ium ?1,9>9 "!m;.;1 sm$i 1;< "!m "!m $e! h!i tu %e(ih (ik .,9 "!m "!m

$e! h!i

• Particle Repositioning Maneu%er ?PRM@

Te%h (nyk $ene%itin yn" mem(uktikn &en"n $em(e!in te!$i &en"n

Particle Repositioning Maneu%er ?PRM@ &$t se-! e'ekti' men"hi%n"kn =e!ti": $&

BPPV, menin"ktkn ku%its hi&u$, &n men"u!n"i !isik: #tuh $& $sien+

Kee'ekti'n &!i mnu=e! (e!=!isi mu%i &!i 20F>.00F+ E'ek sm$in" &!i me%kukn

mnu=e! &%h mu%, munth, =e!ti":, &n nist"mus+ Sete%h me%kukn mnu=e!,

hen&kny $sien tet$ (e!& $& $:sisi &u&uk minim% .0 menit untuk men"hin&!i

!isik: #tuh9+

)' Brandt*Daro++ exercise

19


21/25

O$e!si

Jik "e#% ti&k mem(ik &en"n :(t tu$un te!$i mneu=e!, tin&kn :$e!si $e!%u

&i$!tim(n"kn+ K!en te%in" &%m memi%iki sistem keseim(n"n &n $en&en"!n,

k:m$%iksi &!i :$e!si &%h kehi%n"n $en&en"!n+ Penyuntikn st!e!:i& int!tim$ni

?&emeths:ne@ ke te%in" ("in ten"h &$t men"u!n"i in'%msi &n men"u(h

si!ku%si te%in" ("in &%m+ O$e!si &$t &i%kukn $& $sien BPPV yn" te%h

men#&i k!:nik &n sn"t se!in" men&$t se!n"n BPPV yn" he(t, (hkn sete%h

me%kukn mnu=e!>mnu=e! yn" te%h &ise(utkn &i ts+ In&iksi untuk me%kukn

:$e!si &%h $& intracta"le BPPV, yn" (isny mem$unyi k%inis $enykit neu!:%:"i

=esti(u%!, ti&k se$e!ti BPPV (is+ Te!&$t &u $i%ihn inte!=ensi &en"n teknik :$e!si

yn" &$t &i$i%ih, yitu singular neurectomy ?t!nseksi s!' m$u% $:ste!i:!@ &n :k%usi

kn% $:ste!i:! semisi!ku%!+ Nmun %e(ih &i$i%ih teknik &en"n :k%usi k!en teknik

neu!e-t:mi mem$unyi !isik: kehi%n"n $en&en"!n yn" tin""i.9

Pr#gn#sis

Deth * &u(i & (:nm

Disese * &u(i & (:nm

Dis(i%ity * &u(i & (:nm

Dis-:m':!t * &u(i & (:nm

Disstis'-ti:n * &u(i & (:nm

Destituti:n * &u(i & (:nm

20


22/25


23/25

N&i 3 ;menit 3 ;menit 30; menit 30;mnt

Pe!n$sn 10 ;menit .3 ; menit 10; menit 10;menit

Suhu


24/25


25/25

6" ato# $*, ;ola#d +, $i..i#& i# t& old&r adult, part 1 Caluatio# a#d

g&ral tr&atmt trat&gi&" Geriatric" 2003B5828-38

7" aro#o, 2000, Kapita Selekta Neurologi, :adja ada u#iC&rit< r&

8" uD +"', 2001, =&rtigo a#d $i..< i# eMedicine Journal ; =olum& 2 umb&r 5

9" ardjo#o, 2008" Neurologi Klinis Dasar " 'akarta $ia# ;ak' 2010"

14"Gr&akoatmodjo, 2004" Vertigo $ aspek neurologi" >ogor ?&rmi# $u#iaE&dokt&ra#"

15"L&C&Hu& &t al" 2007" +urgi)al A&rap< i# #tra)tabl& >ig# aro@

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