Does the patient complain of vertigo, a secondary symptom (e.g.

, nausea), a nonspecific
symptom (giddiness*pusing/mabuk* or lightheadedness), or something unlikely to be
caused by dysfunction of cranial nerve VIII (e.g., confusion or syncope)? With respect to
hearing complaints, the clinician should ascertain whether one or both sides are
affected, what types of sounds are poorly perceived (low-pitched, high-pitched, speech
only, or speech with background noise), whether there is an accompanying tinnitus
(ringing, pulsatile, multifrequency sound such as roaring, auditory hallucinations), and
whether there is otalgia or an abnormal sensation in the ear such as fullness. It is
particularly important to inquire*menanyakan* about coincident headaches because
migraine is a frequent source of vertigo.
Next, the physician should inquire about timing. Are symptoms constant or episodic? If
episodic, how long do they last? Vertigo caused by benign paroxysmal positional vertigo
(BPPV) usually lasts 10 seconds. Vertigo from attacks of Mnire's disease typically lasts
2 hours. Vestibular neuritis persists for weeks, and central vertigo may persist for years.
The clinician should establish whether the various symptoms are related in time. This
finding is particularly important for certain disorders that present as symptom
complexes, such as the headache and dizziness of vertebrobasilar migraine or the typical
quadrad of tinnitus, vertigo, aural fullness, and fluctuating hearing that typifies Mnire's
disease.
All patients with vertigo should be queried regarding triggering or exacerbating factors
( Table 12-1 ). In vertiginous patients, it is particularly important to inquire about
positional triggers because approximately 20% of all vertigo is caused by BPPV
Table 12-1 -- Triggering or Exacerbating Factors for Vertigo
Changes in position of the head or body
Standing up
Rapid head movements
Walking in a dark room
Loud noises
Coughing, blowing the nose, sneezing, straining, or laughing
Underwater diving, elevators, airplane travel
Exercise
Shopping malls, narrow or wide open spaces, grocery stores, escalators (visual
sensitivity complex)
Foods, not eating, salt, monosodium glutamate
Alcohol
Menstrual periods or hormonal manipulations
Boat or car travel

Anxiety or stress

A medication history should be taken because numerous medications can induce vertigo
or impair hearing. Anticonvulsants, antihypertensives, and sedatives are common
sources of dizziness and vertigo, and ototoxic medications ( Table 12-2 ) may additionally
be the source of hearing disturbances or ataxia. All current medications as well as
previous exposure to ototoxins should be noted. In people with hearing complaints, a
history of noise exposure should also be obtained.

Table 12-10 -- Common Causes of Central Vertigo

Stroke and TIA
Cerebellum
AICA distribution
PICA distribution
Vertebrobasilar migraine
Adult form
Childhood variant (benign paroxysmal vertigo of childhood)
Seizure (temporal lobe)
Multiple sclerosis, postinfectious demyelination
Arnold-Chiari malformation
Tumors of cranial nerve VIII, brain stem, or cerebellum
Paraneoplastic cerebellar degeneration
Wernicke's syndrome
AICA, anterior inferior cerebellar artery; PICA, posterior inferior cerebellar artery; TIA,
transient ischemic attack
(Goetz: Textbook of Clinical Neurology, 3rd ed)

Neurological symptoms and signs of cerebral ischaemia

and infarction

Combinations of the following suggest vertebrobasilar artery

ischaemia:
double vision (cranial nerves 3, 4 and 6 and connections);
facial numbness (cranial nerve 5);
facial weakness (cranial nerve 7);
vertigo (cranial nerve 8);
dysphagia (cranial nerves 9 and 10);
dysarthria;
ataxia;
loss of use or feeling in both arms or legs.
(Essential.Neurology.4Th.Ed.eBook-YYePG)

.Komplikasi.
Komplikasi penyakit vertigo ini biasanya adalah penyakit meniere, trauma telinga dan labirimitis,
epidemic atau akibat otitis media kronika. Vertigo juga dapat disebabkan karena penyakit pada
saraf akustikus serebelum atau sistem kardiovaskuler.

Transient ischemic attack (gangguan fungsi otak sementara karena berkurangnya aliran
darah ke salah satu bagian otak) pada arteri vertebral dan arteri basiler.

Terkadang vertigo juga merupakan salah satu gejala awal terjadinya stroke ringan,
sebagai akibat pecahnya pembuluh darah akibat tekanan darah tinggi (hipertensi).
Biasanya vertigo yang diakibatkan oleh kurangnya oksigen ke otak ini akan disertai
dengan mual dan muntah-muntah.
Untuk mencegah terjadinya dampak yang lebih berat akibat serangan stroke yang
diawali dengan serangan vertigo, pemeriksaan lainnya adalah CT scan atau MRI kepala,
yang bisa menunjukkan kelainan tulang atau tumor yang menekan saraf. Jika diduga
suatu infeksi, bisa diambil contoh cairan dari telinga atau sinus atau dari tulang
belakang.
Jika diduga terdapat penurunan aliran darah ke otak, maka dilakukan pemeriksaan
angiogram, untuk melihat adanya sumbatan pada pembuluh darah yang menuju ke otak.
KOMPLIKASI
Tinnitus Permanent
dan kehilangan pendengaran total sehingga membutuhkan alat bantupendengaran.
Tinnitus bisa menetap atau hilang-timbul dan semakin memburuk sebelum,
setelahmaupun selama serangan vertigo terjadi.
Ketidak Seimbangan
dan ketulian sehingga dapat menyebabkan kecelakaan akibat dari
gangguankeseimbangan tersebut
K
ehilangan Pendengaran Yang Progresif
K
ehilangan pendengaan sensorineural progresif dan fluktuatif. Secara periodik,
penderitamerasakan telinganya penuh atau merasakan adanya tekanan di dalam telinga. Pada
kebanyakanpenderita, penyakit ini hanya menyerang 1 telinga dan pada 10-15%
penderita, penyakit inimenyerang kedua telingaGangguan pendengaran biasanya
berfluktuasi dan progresif dengan pendengaran yangsemakin memburuk dalam
beberapa hari. Gangguan pendengaran pada penyakit meniere yangparah dapat
mengakibatkan kehilangan pendengaran permanen