Text Book Reading

“Posttraumatic Balance Disorder”

Zuhra Fahlisa Ningsih

G4A018090

PEMBIMBING
dr. Untung Gunarto, Sp. S

SMF SARAF
RSUD PROF. DR. MARGONO SOEKARJO
FAKULTAS KEDOKTERAN
UNIVERSITAS JENDERAL SOEDIRMAN
PURWOKERTO
2019
Introduction
Posttraumatic Balance Disorder
A symptom that is often experienced after head and
neck trauma

Balance
Visual, vestibular, propioseptic and cerebellum
integration

Pasien mentioned posttraumatic balance disorders

Examples : dizziness or vertigo

Insidance posttraumatic Vertigo in US

Between 15-78% of all head trauma
THE HUMAN BALANCE SYSTEM

(Kammermeier, 2010; Baehr and Frotscher, 2014)

ANATOMY

VESTIBULAR SYSTEM consists of 3 canalis semisircularis and

2 otolith organs (sacculus and utriculus)
Canalis semisircullaris : detect head rotation
Sacculus and utriculus : detect the head moves horizontally and
vertivcally (Kammermeier, 2010)
 ETIOPATHOMEC
Otolith ANISM
post- traumatic
Head trauma causes balance disorder
Canalis Semisircullaris otoconia to emerge,
resulting in a floating
Head trauma can lead to sensation
peripheral vestibular
hypofunction and unilateral Central Nervous System
weakness in calorie test
ventricular enlargement,
minor bleeding, and
diffuse axonal injury
occur.
Early Post Traumatic Peripheral Vertigo

BPPV
OTOLITH DISFUNCTION
• Appears some days to weeks
• Posture instability
• Vertigo for 10-30 seconds and is triggered by
• Feels like walking on wool or pillows
changes in head position
• Osilopsia (+)
• If we checking nystagmus, it can stop in a few
second PERILIMPH FISTULA
• Hearing disorder
• Full feeling in ears
LABYRINTHINE CONCCUSION • Tinnitus
• Result form a fracture of the temporal bone • Valsava maneuver (+)
• It can occur without fracture BAROTRAUMA VERTIGO
• SNHL (+) • Full feeling in ears
• Dizziness (+); nausea (+); vomit (+) • Diving (+) or eustachian tube damage
Delay Post Traumatic Peripheral Vertigo

Menier Disease CERVICOGENIC

• Vertigo • Cervical and head pain (+)
• Tinnitus • Whiplash trauma
• SNHL • Hyperlordosis (upper cervical)
• Hyperkifosis (lower cervical)

Posttraumatic Central Vertigo

• Trauma a. Vertebralis
• It can be affected on the cerebellum, brain stem,
pons, mesensefalon
 DIAGNOSIS
Generalis status
• Nystagmus (Dix hallpike manuver,
Vestibular Ocular reflex (VOR))
• Romberg test
• Coordination test

PHYSICAL ADDITIONAL
ANAMNESIS DX
• How did trauma occur? EXAMINATIONS TESTING
• Is it about neck or head? • Calorie test
• What is felt? • CT Scan or MRI
• When does trauma occur? • Electro-oculography
• Is there a headache?
• Tinnitus? Hearingloss?
• Feeling floating, like walking on the pillows?
 MANAGEMENT

ANTIHISTAMIN VESTIBULAR REHABILITATION

Anticholinergic
Ca Channel Bloker Epley Manuver
Benzodiazepin
ANTIEMETIC Brandt-Daroff
 DAFTAR PUSTAKA
Baehr M., Frotscher M. 2014. Diagnosis topik neurologi DUUS: Anatomi,Fisiologi,Tanda,Gejala. Jakarta : Penerbit Buku Kedokteran EGC.
Elzière, M. Devèze, A. Bartoli, C. Levy, G. 2017. Post-Traumatic Balance Disorder. European Annals of Otorhinolaryngology, Head and
Neck diseases. 134: 171–175.
Ernst A, Basta D, Seidl RO, Todt I, Scherer H, Clarke A. 2005. Management of Posttraumatic Vertigo. Otolaryngol Head Neck Surg.
132:554‐8.
Fife, T.D., Giza, C. 2013. Posttraumatic Vertigo and Dizziness. Seminars in Neurology. Vol. 33(3)238-243.
Ganong W.F. 2003. Review of Medical Physiology. 21st ed. USA: The McGrawHill Companies.
Guyton, A.C. Hall, J.E. 2006. Textbook of Medical Physiology. 11th ed. Philadelphia: Elsevier Inc.
Kammermeier, S. 2010. Impaired vestibulo-Spinal Interaction in Cerepatints. Dissertation. Medizinischen Fakultätder Ludwig-
Maximilians-Universität München.
Moore KL, Agur AMR, Dalley, A.F. 2012. Clinically Oriented Anatomy. 4th ed. Philadelphia: Lippincott Williams & Wilkins.
Putri, A.L. 2014. Hubungan Trauma Kepala Ringan sampai Sedang dengan Vertigo Di RSUD Dr. Moewardi Surakarta. Skripsi. Fakultas
Kedokteran Universitas Muhammadiyah Surakarta.
Ramos R.Z., Torre M.G.de la, Maldonado, M.J., Cabrera, T.V., Bañuelos A.R, Portillo L.A., et al. 2013. Post concussion syndrome and mild
head injury. The role of early diagnosis using Neuropsychological test and fMR/spectroscopy. World Neurosurgery,
Vol.82(5):627-628.
Taneja MK, Taneja V., Varshney, H. 2014. Post-traumatic Vertigo. Indian Journal Otology. 20: 95-98
Pathak, A., Panda, N., Khandelwal, N., Das, C.P., Mathuriya, S.N. 2007. Post Head Injury Vertigo. Indian Journal of Neurotrauma. Vol.
4(1):31-3.
Thank you