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VestibulopathyBilateral
dr. Agus Suryawan
Pembimbing:
dr. Ketut Widyastuti, Sp.Sdr. Ni Putu Witari, Sp.S
Stase neurootologi
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Pendahuluan
• Mengenai labirin dan atau sara!"estibular
• A#ut atau progresi! lambat
• $eng#ap atau tida# leng#ap
• %engan atau tanpa perbedaan pada sisiyang ter#ena
• %engan atau tanpa gangguanpendengaran
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&pidemiologi
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&tiologi
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Pato'siologi
Kehilangan !ungsi "estibulo o((ular re)e#sdan "estibulo spinal re)e#s
*. +s(illopsia dan pandangan #abur. Ketida# seimbangan postur dan gaya
-alan
. %e'sit memori spasial dan na"igasi
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V+/
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Pemeri#saan Neurologis
• /omberg test tida# stabil saat mataditutup
• 6alan tandem
• Wal#ing toe1to1heel
• Vestibulo o((ular re)e#s
• 7es #alori
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V+
/
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V+/
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7es #alori
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9llusionary mo"ements o! thesurroundings 0os(illopsia2
+nly during head mo"ements*. Bilateral "estibulopathy
. %isorders o! the o(ular motor system 0peripheral or(entral2
. Vestibular paroysmia 0only in part2=. Benign paroysmal positioning "ertigo
>. 8entral positionalpositioning "ertigo
?. Vestibulo(erebellar ataia
@. Perilymph 'stulas, superior (anal dehis(en(e syndrome. Post1traumati( otolith "ertigo
. 4/otational "ertebral artery o((lusion syndrome5
*C.9ntoi(ation 0e.g., anti(on"ulsants, al(ohol2
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Pengobatan
• Pro'la#sis #ehilangan !ungsi "estibularyang progresi! hindari obat ototo#si#
• Pemulihan !ungsi "estibular penya#itautoimun
• Korti#osteroid 0prednison C mghari D 1=minggu2
• 9munosupresan
• Mening#at#an #ompensasi danpenggantian !ungsi "estibular hilangdengan terapi 'si# substitusi "isual
dan somatosensori
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7&/9MA KAS9;
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8oganEssyndro
me
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Figure .**. a Aial pro-e(tion, 7*1weighted, two1dimensional !ast low angle shot 0%1F$AS;2, no (ontrastmedium. 8oganEs syndrome, suba(ute stage. Signs o!suba(ute haemorrhages are the signal in(reases in the
"estibule 0short arrow2 and in the (o(hlea 0long arrow2Gbaial pro-e(tion, 7*1weighted %1F$AS; a!teradministration o! Hd1%7PA in the same patient. 8learenhan(ement by (ontrast medium in the area o! thehaemorrhage, namely in the (o(hlea 0long arrow2 and in the
"estibule 0short arrow2G (aial pro-e(tion, 71weightedturbo1s in1e(ho ima in , no (ontrast medium, in a atient
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•
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• 8old (alori(s in a (omatose patient with an inta(tbrainstem (auses toni( de"iation o! the eyes toward
the side o! irrigation as the normally a(ti"e labyrinthpushes the eyes toward the hypoa(ti"e, irrigatedlabyrinth. 9n an awa#e patient, (old (alori(s (ausenystagmus with the !ast (omponent away !rom theirrigated side be(ause the (erebral (orte produ(es a(ompensatory sa((ade that -er#s in the dire(tionopposite the toni( de"iation.
• 7he !amiliar mnemoni( 48+WS5 0(old opposite,warm, same2, re!ers to the !ast phase o! thenystagmus, not to the toni( gaIe de"iation.Nystagmus is seen only when the (orte is!un(tioning normally.
• Warm water irrigation has opposite eJe(ts. Bilateralsimultaneous (old (alori(s indu(e toni( downgaIe,warm (alori(s upgaIe.
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Fungsi u-i #alori
•menilai dan mere#am !ungsilabirin se(ara terpisah
•/espon yang dihasil#an oleh u-i#alori ini berhubungan dengansistem sara! pusat
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Me#anisme
• menge"aluasi !ungsi dari #analis semisir(ularishoriIontal
• perubahan temperature pada #analis auditi"a
e#sterna a#an ditransmisi#an #e #analissemisir#ularis
• ter-adi perubahan pada densitas endolymph di#analis semisir#ularis horiIontal yang se(araanatomi lebih de#at #e liang telinga
• Menyebab#an #ino(ilium bergera# mende#atiutri#ulus
• mening#at#an ambang letup dari sel1sel rambut
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• air yang lebih dingin dari suhu tubuh a#an
menyebab#an ter-adinya aliran ampullo!ugal
• men-auh#an #ino(ilium dari utri#ulus, sertamenginhibisi ambang letup pada sel1sel rambut
• Perangsangan sel1sel rambut pada per(obaan dengan
air hangat tadi a#an menstimulasi nu(leus N 999ipsilateral dan N V9 #ontralateral
• Menyebab#an ter-adinya /e)e#s Vestibulo1o#ularyang menghasil#an de"iasi mata #e arah yang
berlawanan dari telinga yang dialiri dan men(etus#annistagmus #e arah telinga yang dialiri
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• Perangsangan dengan air dingin a#anmenghasil#an de"iasi mata #e arahtelinga yang dialiri dan men(etus#an
nistagmus untu# meng#ore#si arah bolamata #e arah yang berlawanan
• ;al ini sering dising#atsebagai 8+WS08old +pposite Warm Same2
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Fisiologi
• Salah satu !ungsi dari sistem motoro#ular adalah untu# menstabil#angambar pada retina 0terutama !o"ea
pusat2 saat pergera#an mata dan #epala.• Hera#an 9n"olunter atau abnormal mata gera#an berlebihan dari gambar padaretina penglihatan #abur dan
os(illopsia disorientasi spasial,gangguan #eseimbangan postural dan"ertigo.
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• Nystagmus Fisiologis ter-adi selama rotasi tubuhdalam ruang atau selama mata bergera#mengi#uti benda bergera# pandangan yang
-ernih 0masing1masing "estibular dan nistagmusopto#ineti(2.
• Nistagmus patologis mata bergera# -auh daritarget "isual menurun#an pandangan.
• Paling umum, nistagmus terdiri melen(eng dari
targer, misalnya #arena #etida#seimbangan"estibular, #ore#si dengan gera#an (epat0sa((ades2, membawa target "isual yang#embali #e !o"ea 0-er# nystagmus2.
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• V+/ #ompensasi rotasi mata dengan laten(ypende# dan pada bidang yang sama tapi
berlawanan arah dengan rotasi #epala.• Hangguan pada "estibular peri!ermenyebab#an nystagmus dalam arah yangditentu#an oleh pola #analis semisir#ularislabirin yang terlibat.
• Hgn "estibular peri!er nistagmus horiIontalrotator
• Hgn "estibuler sentral upbeat, downbeat, ortorsional nystagmus 0see below2G typi(ally a
straight horiIontal beating nystagmus 0e.g. norota1 tional (omponent2 or nystagmus beats notin the dire(1 tion o! the stimulated semi(ir(ular(anal 0e.g. (ross 1 (oupling2
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• Another (onse3uen(e o! "estibular disease is a (hange inthe siIe 0gain L eye "elo(ity di"ided by head "elo(ity2 o! theo"erall dynami( V+/ response.
• As a result o! this (hange, patients (omplain o! os(illopsiaduring rapid head mo"ements.
• A V+/ gain larger than * 0i.e. eye "elo(ity e(eeds head"elo(ity2 results !rom a disinhibition o! the brainstem (ir(uitsresponsible !or the V+/ and is (aused by (entral, "estibulo1(erebellar dys!un(tion.
• $oss o! peripheral "estibular !un(tion (auses impaired "isionand os(illopsia during lo(omotion, due to the inability to(ompensate !or the high 1 !re3uen(y head perturbations thato((ur with ea(h !ootstep, i.e. the gain o! the V+/ remainstoo low !or gaIe stabiliIation a!ter peripheral "estibular
lesions.• 7he treatment o! os(illopsia due to bilateral "etibular !ailure
0e.g. idiopathi(, gentamy(in intoi(ation, postmeningiti(,due to autoimmune diseases, and idiopathi( is "estibularrehabilitation in(luding head 1 eye (oordination eer(ises.
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