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    Tatalaksana Stroke Vertebrobasilar

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    Marest Askyna
    1. Vertebrobasilar stroke (SVB) accounts for 30% of ischemic stroke cases and can be caused by blockages, bleeding, or embolisms in the vertebrobasilar system affecting the medulla, pons, midbrain, cerebellum, thalamus and occipital cortex. 2. Risk factors for SVB include hypertension, diabetes, hypercholesterolemia, hyperuricemia, and smoking or alcohol use. 3. Diagnosis involves differentiating central from peripheral vertigo through focused history and exam, as well as tests like CT/MRI of the head and neck, TCD, and BERA. Treatment includes controlling risk factors, causal therapies

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    Tatalaksana Stroke Vertebrobasilar

    Uploaded by

    Marest Askyna
    32 views20 pages
    1. Vertebrobasilar stroke (SVB) accounts for 30% of ischemic stroke cases and can be caused by blockages, bleeding, or embolisms in the vertebrobasilar system affecting the medulla, pons, midbrain, cerebellum, thalamus and occipital cortex. 2. Risk factors for SVB include hypertension, diabetes, hypercholesterolemia, hyperuricemia, and smoking or alcohol use. 3. Diagnosis involves differentiating central from peripheral vertigo through focused history and exam, as well as tests like CT/MRI of the head and neck, TCD, and BERA. Treatment includes controlling risk factors, causal therapies

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    1. Vertebrobasilar stroke (SVB) accounts for 30% of ischemic stroke cases and can be caused by blockages, bleeding, or embolisms in the vertebrobasilar system affecting the medulla, pons, midbrain, cerebellum, thalamus and occipital cortex. 2. Risk factors for SVB include hypertension, diabetes, hypercholesterolemia, hyperuricemia, and smoking or alcohol use. 3. Diagnosis involves differentiating central from peripheral vertigo through focused history and exam, as well as tests like CT/MRI of the head and neck, TCD, and BERA. Treatment includes controlling risk factors, causal therapies

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    32 views20 pages

    Tatalaksana Stroke Vertebrobasilar

    Uploaded by

    Marest Askyna
    1. Vertebrobasilar stroke (SVB) accounts for 30% of ischemic stroke cases and can be caused by blockages, bleeding, or embolisms in the vertebrobasilar system affecting the medulla, pons, midbrain, cerebellum, thalamus and occipital cortex. 2. Risk factors for SVB include hypertension, diabetes, hypercholesterolemia, hyperuricemia, and smoking or alcohol use. 3. Diagnosis involves differentiating central from peripheral vertigo through focused history and exam, as well as tests like CT/MRI of the head and neck, TCD, and BERA. Treatment includes controlling risk factors, causal therapies

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    TATALAKSANA STROKE

    VERTEBROBASILAR
    Oleh Sri Sutarni
    Divisi Neuro – Otologi
    Dept Neurologi FK-KMK UGM/
    RSUP Dr. Sardjito, Yogyakarta
    Pendahuluan
    ◦ Stroke Vertebro Basilar (SVB) mempunyai manifestasi klinis mirip Stroke pada umumnya
    ◦ Insidensinya mencapai 30% dari kasus Stroke iskhemik
    ◦ Insufisiensi Vertebrobasilar terjadi karena adanya hambatan aliran darah, perdarahan,
    emboli di bagian belakang Otak TIA, SVB
    ◦ 70 - 80% topik di Medula, Pons, Midbrain, Serebelum, Thalamus & Korteks Oksipital
    ◦ Stenosis arteria Vertebralis dapat  perubahan tensi & posisi kepala  Vertigo, pada
    25% kasus Stroke
    1. Stenosis, rotasi arteria Vertebralis  tekanan darah turun
    mendadak, berulang  SVB

    2. Arteriosclerosis arteria Vertebralis  rupture  emboli  TIA, SVB

     manula  proses Degenerasi

     usia muda: perokok, Alkoholik


    3. Faktor risiko: Hipertensi, Diabetes Melitus, Hiperkholesterolemia,
    Hiperurisemia, dll  SVB
    Elderly
     The definition of Elderly: a few of reference said about more than
    65 years old etc
     Degeneration Process for all of the condition among these Group
     Vertigo in Elderly consist of the Receptor in Middle Ear Systema,
    Visual & Proprioceptif Origin
     When the Compensation being active  no Complain
     With 2 Complain minimal & Disturbance of the

    Compensation  Chronical Process & Disequilibrium


    Definition of Vertigo
     Sensation when the patient feel as though everything is moving even when standing perfectly

    Definition of Dizziness:
     A sensation of spinning around and losing one”s balance, ranging from lightheadedness,
    unsteadiness to vertigo
    Etiology
     Multipel risk factors:
    Cardiolovascular, Neurology,
    Visual,Ear Nose & Throat: Vestibulair, Physiology
    Thirty percent of more than 65 years old ever Vertigo
     The third number to treat by General Practitionair

    Fifty percent for more than 85 years old


     The Clinical manifestation of Vomiting, Nausea, & Disequilibrium

     Infection of Inner Ear, Traumatic Brain Injury  ?

     Long Treatment of Medicine


     Sixty seven percent Vertigo in Elderly usually combine with Cephalgia more than 6 month

     Disequilibrium, Inactivity & Increase of Fall

    Ethiology:

     Internal Factor
     External Factor
    DIAGNOSIS

    INTERNAL FACTOR
    1. Benign Paroksismal Positional Vertigo (BPPV):
     The Most Case  Disturbance of Activity
     Inner Ear Deviation cause by Movement of the Head
    when wake up, Sleep & Sit
    4. Topik di Batang otang  Multipel Kranial disturbans: Perioral
    numbness, Drop attack, lateralisasi dapat (+) atau (-), Lightheadiness,
    Dizziness, Vertigo  Disartria, Diplopia, Dysphagia

    5. Vertebra Cervikalis bisa terlibat  Cervikogenik Vertigo


    ◦ Penting membedakan Vertigo Sentral, Perifer atau
    Mixed type
    ◦ Vertigo Sentral biasanya tidak terlalu mendadak, karena
    ada fase adaptasi untuk faktor risiko yang berlangsung
    dalam jangka waktu lama
    ◦ Kejadian mendadak karena presipitating faktor setelah
    tidak dapat mengatasi faktor risiko yang terjadi
    Vertigo or Dizziness in Elderly ask first to
    the Patient & family
    1. Did the patient drink Antihypertension before? Side effect of
    Medicine: 23%
    2. Spinning in anamnesis  BPPV? Peripheral Vestibular: 14%
    3. Otologic Dizziness in Elderly is potentally
    4. Heart Disease?  Presyncope 69%; Cardiovascular: 57%
    5. Rotatory vertigo?  Change position of the Head, Exacerbation?
    Rolling over in Bed? Spinning Component?
    6. The Ethiology are Complex & Multifactorial > 1 Ethiology: 44%
    7. Postural Stability? Physiotherapy 

    8. Combined with Cephalgia, Sinusitis or Orthostatic Hypotension


    9. Psychiatric Case: Depression / Anxiety: 10% Psycho therapy
    10.Visus Disturbance Correction
    11.The Correlation among Dizzy & Brain, Heart, Anaemia, Urine Infection, Pneumonia etc
    Anamnesis:  sesuai dengan Ax. Stroke Infark/ Perdarahan, faktor risiko
    multipel kranial disturbans
    ataksia, disequilibrium
    bedakan Vertigo Sentral, Perifer/ Mixed type

    Pemeriksaan Klinis Neurologis:  Umur, Hipertensi dll


    Lateralisasi? Multipel kranial disturbans?
    Vertigo sentral
    AGE DEPENDENT >< POSTURAL STABILITY

     Age dependent: Deteorioration for Central & Peripheral Vestibular System  Cell mechanism of
    Aging is decrease cause by degeneration process  the mechanism is unclear
     Theory about genetic predisposition & cummulative effect of oxydative stress
     Postural stability: Integrity somatosensoric, Visual & Vestibular inputs  Musculosceletal system
    MANAGEMEN
    1.Position of the Head:
     Slow movemen of the Head
     Head Position is higher compare the Body
     Decrease movemen to see the Upper Position of the Head
     Vestibulair excercise for Dizziness: Dix Hallpike maneuver
    2. Central vertigo

     Gait training

     Strengthtening sensory function >< Vestibulair dysfunction

     Decrease anti vertigo treatment & compensir with

    rehabilitation excercise
    3. Causalis Therapy

     Cardiovascular: EKG & Echocardiography  consult to


    Cardiologist, Decompesatio cordis?
     Deaffness: Cerumen prop  consult to ENT specialist
     Decrease of Visus: correction to Ophthalmologist
     Medicine side effect?  stop that medicine
    Pemeriksaan Penunjang :  lab darah faktor risiko
     Ro thoraks, EKG
     CT scan / MRI:
    kepala sentrasi batang otak
    TCD, BERA, MRA
    Terapi :  Simptomatis  Vertigo: Flunarizine
    sesuaikan dengan keluhan pasien
    Kausalis :  Stroke Infark, Perdarahan, Emboli?
    Kendalikan faktor risiko
    Rehabilitasi:  Senam Equilibrium, Vertigo
    KESIMPULAN
    1. SVB cukup besar insidensinya, bahkan meningkat dari waktu ke waktu tidak hanya
    manula tetapi merambah keusia muda
    2. Anamnesis yang terarah, pemeriksaan terfokus, diagnosis tepat perlu ditegakkan
    agar terapi tepat
    3. Dapat membedakan jenis Vertigo, apakah tipe Sentral, Perifer atau tipe campuran
    4. Derajad Vertigo apakah Lightheadeness, Dizziness, Disequilibrium atau Vertigo?
    5. Multipel kranial disturbans perlu diperhatikan
    6. Gaya hidup, pengendalian faktor risiko, terapi kausal, simptomatis, rehabilitatif
    edukasi perlu dilakukan secara berkesinambungan
    7. Flunarizine sebagai Kalsium entry Blocker direkomendasikan untuk keluhan Vertigo
    sentralnya

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