H.I.N.T.S.

AND
VERTIGO

Dr. Novy Rosalia Chandra

Residen Neurologi FK UNSRI
PERBEDAAN VERTIGO SENTRAL DAN PERIFER
Komponen Vertigo Perifer Vertigo Sentral
Temuan pada manuver Dix-Hallpike
Latensi gejala dan nystagmus 2–40 detik Tidak ada (langsung)

Keparahan vertigo Berat Ringan

Durasi nistagmus < 1 menit > 1 menit
Fatigability1 Ya Tidak
Habituation2 Ya Tidak
Temuan lain
Postural instability Mampu berjalan; unidirectional Terjatuh saat berjalan; severe
instability instability
Hearing loss atau tinnitus Dapat timbul Biasanya tidak ada

Other neurologic symptoms Tidak ada Biasanya ada

1 Response remits spontaneously as position is maintained.

2 Attenuation of response as position repeatedly is assumed.
 ACUTE, CONTINUOUS DIZZINESS
DEFINITION OF ACUTE VESTIBULAR
SYNDROME
 acute, continuous dizziness, vertigo, or gait
ataxia lasting days to weeks with nausea or
vomiting, head motion discomfort, nystagmus
 ‘Post-Exposure’ and ‘Spontaneous’ forms
 Post-Exposure: anti-epileptic drugs
 Spontaneous: vestibular neuritis, stroke

This is NOT episodic

Newman-Toker
 ACUTE, CONTINUOUS
DIZZINESS
SPONTANEOUS AVS
 Peripheral and central vestibular causes
 ~75% peripheral (vestibular neuritis/labyrinthitis)
 ~25% central (80% stroke, almost all ischemic)

Newman-Toker
 H.I.N.T.S.

Head Impulse Nystagmus Test of Skew

DIRECTION-CHANGING NYSTAGMUS IS
CENTRAL
MIXED VESTIBULAR/GAZE-HOLDING
 Vestibular  Gaze-Holding
(usually peripheral, (central, most typical of
typical of neuritis) cerebellar degeneration)

Unidirectional Bi-directional
 ACUTE, CONTINUOUS
DIZZINESS (DAYS)
ACUTE VESTIBULAR SYNDROME
Impulse Test Nystagmus Skew DIAGNOSIS
Abnormal Unidirectional Absent
Abnormal Unidirectional Present
Abnormal Bidirectional Absent
Abnormal Bidirectional Present
Normal Unidirectional Absent
Normal Unidirectional Present
Normal Bidirectional Absent
Normal Bidirectional Present
 ACUTE, CONTINUOUS
DIZZINESS (DAYS)
ACUTE VESTIBULAR SYNDROME
Impulse Test Nystagmus Skew DIAGNOSIS
Abnormal Unidirectional Absent Neuritis
Abnormal Unidirectional Present
Abnormal Bidirectional Absent
Abnormal Bidirectional Present
Normal Unidirectional Absent
Normal Unidirectional Present
Normal Bidirectional Absent
Normal Bidirectional Present
 ACUTE, CONTINUOUS
DIZZINESS (DAYS)
ACUTE VESTIBULAR SYNDROME
Impulse Test Nystagmus Skew DIAGNOSIS
Abnormal Unidirectional Absent Neuritis
Abnormal Unidirectional Present Stroke
Abnormal Bidirectional Absent Stroke
Abnormal Bidirectional Present Stroke
Normal Unidirectional Absent Stroke
Normal Unidirectional Present Stroke
Normal Bidirectional Absent Stroke
Normal Bidirectional Present Stroke
 PEMERIKSAAN
NEUROLOGIS
 Past-ponting test (Uji Tunjuk
• TES ROMBERG  Tandem Gait Barany)

 Uji Unterberger

 Uji Babinsky-Weil
 PEMERIKSAAN KHUSUS OTO-
NEUROLOGIS
• FUNGSI VESTIBULER
o UJI DIX-HALLPIKE
o TES KALORI
o ELEKTRONISTAGMOGRAM

• FUNGSI PENDENGARAN
o TES GARPU TALA
o AUDIOMETRI
MANUVER DIX-HALLPIKE
MANUVER EPLEY
MANUVER SEMONT
MANUVER LEMPERT
 Terimakasih..
Semoga bermanfaat..
Amin