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