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Benign Paroxysmal Positional Vertigo

(BPPV)

PEMBIMBING :

DR. dr. DESSY R. EMRIL, Sp.S(K)

DOKTER MUDA :

Khairul Rial

!"#$!#!#%#&'#

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PENDAHULUAN

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IDENTITAS PASIEN

Naa : NY. NA *+i- K+lai : P+r+pua

U-ia : !ahu BB : // 01

TB : !'# 2

BMI : &!."3

Alaa : Si1li

Sau- P+r0a4ia : M+i0ah

A1aa : I-la

P+0+raa : I5u Ruah Ta11a

Su0u Ba1-a : 6NI N7 RM : !#'8!&!

Ta11al Kuu1a RS : #/ N79+5+r !/

P7li0lii0 : Sara

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ANAMNESIS

K+luha Uaa da RPS

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Pemeri"saan #isi"

K+adaa Uu : Sa0i ri1a

K+-adara : ;7p7- +i-

G;S : E"M'1

Nadi : 3$ ?=+i

Suhu : %'," 7;

P+raa-a : ?=+i

B+ra Bada : // 01

Ti11i Bada : !'# 2 Sau- Gi@i : 5ai0

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Kepala

B+u0 : 7r72h+pali, -i+ri

N+ri +0a : ()

Ra5u : Puih 5+ru5a, di-ri5u-i +raa, -u0ar di2a5u

6aah : -i+ri-, pu2a (), i0+ri0 (), p++0i+ ()

Maa : +d+a 0+l7pa0 aa (=), pupil 5ula i-707r C %%, R;L (=),

R;TL (=) 07u1i9a a+i- (=), -0l+ra i0+ri0 (=), -+0r+ (=), p7-i-

(=), la17alu- (=), -ra5i-u- (=) >idu1 : Si+ri- , -+pu d+9ia-i (), d+7ria- (), -+0r+ (=)

T+li1a : 7r7ia, p+d+1ara 7ral, +ri +0a a-7id ()

Gi1i Mulu : 0ari+- 1i1i (), p+rdaraha 1u-i (), 7ral hygiene2u0up 5ai0.

Lidah : Tr+7r (), hip+r+i- (), par+-+-ia () papil ar7i ()

T+117r70a : 7ral, ida0 hip+r+i-, 7-il T!T!

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Leher

I-p+0-i : Si+ri-, p+5+-ara KGB (), di-+-i 9+a u1ular

(=)

Thorax I-p+0-i

Sai- : Si+ri-, 5+u0 7r72h+-

Diai- : P+raa-a h7ra0al a5d7ial, r+ra0-i -upra-+ral (),

r+ra0-i i+r27-al (), r+ra0-i +pi1a-riu ()

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Paru

I-p+0-i : Si+ri- -aa -ai- da diai-

Palpa-i : Kaa Kiri

D+pa Fr+iu- N Fr+iu- N

B+la0a1 Fr+iu- N Fr+iu- N

P+r0u-i : Kaa Kiri

D+pa S77r S77r

B+la0a1 S77r S77r

Baa- paruh+par : I;S I< d+0-ra

Au-0ula-i : Kaa Kiri

D+pa

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$ Jantung

$ Ins%e"si & A%e"s 'antng tia" terli*at

$ Pal%asi & A%e"s 'antng tia" tera+a

$ Per"si & Batas,+atas 'antngAtas & I-S III linea %arasternalis sinistra

iri & I-S V linea mi,/la0i/la sinistra

anan & I-S IV linea %arasternalis extra

$ As"ltasi & B1 I 2 B1 II 3 regler3 murmur(,)3 gallop(,)

$ Abdomen

$ Ins%e"si & Datar3 istensi (,)3 0ena "olateral (,)

$ As"ltasi & Peristalti" (4) "esan normal

$ Pal%asi & 5assa tmor (,)3 nyeri te"an (,)3 e6ans ms/lar (,)

$ He%ar & tia" tera+a

$ Lien & tia" tera+a

$ 7in'al & Ballotement (,)

$ Per"si & Tim%ani (4) %aa 8 regio a+omen3 As/ites (,)

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$ Genitalia

Tia" i%eri"sa

$ Anus

Tia" i%eri"sa$ Tulang Belakang

Bent" & normal3 e6ormitas (,)3 nyeri te"an (,)

$ Kelenjar Limfe

Pem+esaran 7B & Tia" i'm%ai

$ Ekstremitas, S%erior & I & Eema (,9,)3 "emera*an (,9,)3 to6s (,9,)

P & a"ral tera+a *angat (,9,)3 oeem (,9,)

A & "re%itasi (,9,)

, In6erior & I & Eema (,9,)3 "emera*an (,9,)3 to6s (,9,)

P & a"ral tera+a *angat (,9,)3 oeem (,9,)

A & "re%itasi (,9,)

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Pemeri"saan Stats Nerologis

G;S : E"M'

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Ner0s -ranialis

N+r9u- ;raiali- I

(N+r9u- Ola27riu-) dala5aa- 7ral

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Ner0s -ranialis II (Ner0s

:%ti"s) alam +atas normal

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Ner0s -ranialis III 3 IV3 an VI

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Ner0s -ranialis V ( Ner0s

Trigemins) alam +atas normal

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Ner0s -ranialis VII (ner0s

#a/ialis) alam +atas normal

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Ner0s -ranialis VIII (Ner0s 0esti+lotro/*learis)

N - i li I; (

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Ner0s -ranialis I; (ner0s

7losso%*arynges) alam +atas

normal

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Ner0s -ranialis ; (ner0s Vags)

alam +atas normal

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$ Ner0s -ranialis ;I ( Ner0s A//esoris)

#ngsi ari ms/ls tra%e

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$ Ner0s -ranialis ;II (ner0s Hi%oglosss)#ngsi otot %enggera" lia* an %ergera"anlia* alam +atas normal.

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Pemeri"saan motori" & alam +atas

normal

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Pemeri"saan Sensori"

=e6le"s sensoris

ra+a an nyeri alam+atas normal

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=e6le"s 6isiologi

() 7ral

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=e6le"s Patologis negati6

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$ #ngsi "oorinasi an "eseim+angan &

=om+erg tes Positi6 1at* se+ela* "anan

$ Sistem otonom & +ai"

$ #ngsi l*r & tia" aa ganggan

$ Verte+rae & tia" aa "elainan

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Diagnosis$ Diagnosis linis &

Benign Paro"sismalPosisional Vertigo

$Diagnosis Etiologi &Vertigo Iio%ati

$ Diagnosis To%i" &

Vertigo Vesti+lar

$ Penatala"sanaan

Non 5ei"amentosa$ Tera%i non mei"amentosa

%aa BPPV a%at ila""anengan %em+erian tera%i

man0er re%osisi %arti"el9Particle RepositioningManeuver (P=5) yanga%at se/ara e6e"ti6meng*ilang"an 0ertigo %aaBPPV

5ei"amentosa$ Para/etamol >x?@@mg$ 5e/o+alamin !x!?@ m/g

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$ Prognosis &$ A 0itam & +ia a +onam

$ A 6ngsionam & +ia a +onam

$ A sana/tionam & +ia a +onam

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TIN1AUAN EPUSTAAAN

Vertigo mer%a"an

"el*an yang sering

i'm%ai alam

%ra"te" yang seringigam+ar"an se+agai

rasa +er%tar3 rasa

oleng3 ta" sta+il

(giiness3nsteainess) ata

rasa %sing

Vertigo +erasal ari +a*asa

Latin 0ertere yang artinya

memtar mer'" %aa

sensasi +er%tar se*inggamenggangg rasa

"eseim+angan seseorang3

mmnya ise+a+"an ole*

ganggan %aa sistim"eseim+angan

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Etiologi BPPV

$ Penya"it system 0esti+lar %eri6er ( yait la+irin3

ner0s VIII ata inti 0esti+laris)

$ Ner0s VIII & In6e"si3 Trama3 Tmor

$ Penya"it ssnan sara6 %sat &

Vas/lar& Is"emi" ota"3 Hi%ertensi "ronis3

Arterios"lerosis3 Anemia3 Hi%ertensi

"ario0as/larIn6e"si & meningitis3 ense6alitis3 a+ses

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7e'ala linis BPPV$ Peri6er

. %anangan gela%

!. rasa lela* an stamina menrn

>. 'antng +ere+ar

. *ilang "eseim+angan

?. tia" mam% +er"onsentrasi. %erasaan se%erti ma+"

C. otot terasa sa"it

. mal an mnta*,mnta*

8. memori an aya %i"ir menrn

@. sensiti6 %aa /a*aya terang ansara

. +er"eringat

$ Sentral. %engli*atan gana

!. s"ar menelan

>. "elm%*an otot,otot a'a*

. sa"it "e%ala yang %ara*?. "esaaran tergangg

. tia" mam% +er"ata,"ata

C. *ilangnya "oorinasi

. mal an mnta*,mnta*

8. t+* terasa lema*

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Pato6isiologi BPPV

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Penega"an iagnosis

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Tatala"sana BPPV

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5an0er E%ley 5an0er Semont

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Analisa assPa-i+ N. Na, u-ia '& ahu daa1 0+P7li0lii0 Sara, RSUDA BadaA2+h, pada a11al #/ N79+5+r !/d+1a 0+luha 0+pala +ra-a pu-i15+rpuar +ruaa 0+i0a 0+pala5+r1+ra0 aau 5+rpidah p7-i-i -+2arai5ai5a -+a0 / hari a1 lalu.

B+rda-ar0a +7ri di aa-, K+luhapu-i1 5+rpuar a1 di0+luh0a pa-i++ra 0aiaa d+1a BenignParoksismal Posisional Vertigo(BPP

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Pasien mer%a"an seorang%erem%an yang sa* +ersia !ta*n an s"a ma"an ma"anan yangmanis an +erlema"

pa-i+ +ili0i -+ulah a07r r+-i07-+p+ri a1 +lah di5aha- -+5+lua,aiu a07r u-ia, diaa u-ia pa-i+adalah J'# ahu, +i- 0+lai, diaa+lah dia5il hip7+-a 5ah4a, pa-i+d+1a +i- 0+lai 4aia l+5ih -+ri1

+d+ria BPP< daripada la0ila0i. Dari-+1i 7-+ BPP< 5ia-aa did+ria padau-ia /#$# ahu, Pr7p7r-i aara 4aial+5ih 5+-ar di5adi10a d+1a la0ila0iaiu &,& : !,/Se*ingga %aa "ass terse+t 1+ala

1+ala 0lii- a1 di0+luh0a 7l+h pa-i++du0u1 0+ arah p+a0i 9+ri17diaa, 0ia 0+ahui 0+luha 9+ri17 dapa+radi i5ai5a pada p+ru5aha p7-i-i0+pala da 5+rla1-u1 dala 4a0u-i10a.

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esim%lan

Pa-i+ . NA, u-ia '& ahu, daa1 0+ P7li0lii0Sara RSUDA, Bada A2+h. Pa-i+ +1+luh0a0+pala +ra-a pu-i1 5+rpuar 0+i0a 0+pala 5+ru5ah

p7-i-i -+2ara i5ai5a, hal ii dira-a0a pa-i+ +ruaa

0+i0a a0a 5a1u dari +pa. S++lah +la0u0ap++ri0-aa, da 5+rda-ar0a 0+luha a1 did+riapa-i+, pa-i+ didia17-a d+1a B+i1 Par7?-alP7-ii7al

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TE=I5A ASIH