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 Ménière'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 Ménière'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

a history of noise exposure should also be obtained. transient ischemic attack (Goetz: Textbook of Clinical Neurology. anterior inferior cerebellar artery. All current medications as well as previous exposure to ototoxins should be noted. antihypertensives. Anticonvulsants. postinfectious demyelination Arnold-Chiari malformation Tumors of cranial nerve VIII. or cerebellum Paraneoplastic cerebellar degeneration Wernicke's syndrome AICA. PICA. Table 12-10 -. and ototoxic medications ( Table 12-2 ) may additionally be the source of hearing disturbances or ataxia. posterior inferior cerebellar artery. 3rd ed) Neurological symptoms and signs of cerebral ischaemia and infarction . In people with hearing complaints.Anxiety or stress A medication history should be taken because numerous medications can induce vertigo or impair hearing. brain stem.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. and sedatives are common sources of dizziness and vertigo. TIA.

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

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

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

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