Vertigo is constitute the subjective complaint which it often require a patient come to find physician helping quickly. Vertigo is an illusion where a person who suffer it is feeling his body move toward his environment or otherwise. According to Oosterveld, be found about 100 kinds of diseases can give vertigo symptom.
Physio anatomic, human body balance system including of three systems i.e. Vestibular system, Visual system, and Proprioseptive. All of these three systems collaborate to regulate human equilibrium. If happen disorder on one of all systems, so the vertigo complaint will appear.
There are some theories of phato-physiology happening of vertigo, but which more be followed are neural mismatch / sensory rearrangement theory and sinaps theory. Neural mismatch theory is spoken by Reason that vertigo complaint appear because occur mismatching of movement experience which be saved in brain with movement that is going on. That case be happened as consequence of disorder on system which is watching body equilibrium. That mismatching stimulation with existed pattern will stimulate over brain activity included autonomous nerve system, then appear vertigo symptom be followed queasy, vomit and cold perspiration. After that will occur rearrangement of movement pattern which is going on ( sensory rearrangement ) until occur adaptation and vertigo will stopped.
Accordance with the second theory i.e. Sinaps theory, symptom of vertigo appear be begun by release of corticotrophin releasing factor/hormone ( CRF/CRH ) of hypothalamus consequence of physical stimulation ( movement ), organic disorder or psychic ( stress ). Raising of CRF will stimulate sympathetic nerve system on coeruleus locus, hypo campus, brain cortex, hypophyse, and lymphocyte cell. That other so happened release of neurotransmitter like as glutamate, histamine, acethylcholin and noradrenalin.
In facing a patient with vertigo sign be needed investigation carefully including of patient complaint and comprehensive physical examination to establish the kind of vertigo and location of lesion, so to determine of etiology and therapy. Vertigo be differentiated became two kinds i.e. : Vertigo vestibular and Vertigo non vestibular. Vertigo vestibular is vertigo which appear as consequence of disorder on vestibular system, and Vertigo non vestibular is vertigo which appear as consequence of disorder on visual and proprioceptive systems. Clinical manifestation of Vertigo vestibular :
- Vertigo characteristic like rotate.
- Attack characteristic episodic.
- Be followed autonomic symptom and tinnitus.
- Be sparked by head movement.
Vertigo vestibular be divided became two types i.e. : periphery ( on labyrinth or vestibular nerve ) and central ( on brain stem until to brain cortex ). In a clinical manner on vertigo vestibular periphery type vertigo complaint more severe, autonomic sign more severe, very be influenced by head movement and sometime be found tinnitus. But on vertigo vestibular central type showing the symptoms milder and there is not tinnitus, however be found presence of neurologist deficit.
The clinical symptoms of vertigo non vestibular are as below :
- Fly sensation with characteristic continuously.
- Without autonomic sign.
- It did not be influenced by change of position.
- The Complaint increasingly severe if be in noisy place.
As the etiology of vertigo vestibular type periphery are Benign Paroxysmal Positional Vertigo, Meneire’s disease, neuritis vestibular, labyrinth infection, traumatic, and tumor of N.VIII. Whereas the etiology of vertigo vestibular type central are cerebrovascular disease, traumatic, tumor, epilepsy, degenerative disease, demyelinisation disease, para neoplastic syndrome and migraine vestibular.
Physical investigation that need be done including of vital sign, general physical examination, and complete neurological examination. Supporting investigation be depended of the etiology of vertigo, Some of it are as below:
- Laboratories : complete blood check, profile lipid, uric acid, and complete homeostatic.
- Cervical photo, CT Scan, Arteriography.
- Neurophysiology : EEG, EMG.
- Calorie Test, Audiometri.
The principal therapy on vertigo cases include of causal therapy, symptomatic therapy, and rehabilitative (vestibular exercise). Anti vertigo medicine that more be used i.e. :
- Antihistamine groups : Sinarisin, prometazine, difenhidinat.
- Ca-channel blocker group : Flunarisin.
- Phenotiazine groups : prokloperazine, Chlorpromazine.
- Histamine group : betahistin.
In choice anti vertigo medicine better be prioritized on medicine with minimally side effect.