REFERAT REFERAT
Gangguan Keseimbangan pada Lansia Gangguan Keseimbangan pada Lansia
Pembimbing: Pembimbing: Dr dr Yuda Turana, SpS Dr dr Yuda Turana, SpS Disusun oleh: Disusun oleh:
Lydia Agusina !"#$%&#'$&##( ) Lydia Agusina !"#$%&#'$&##( )
KEPA*+TERAA* KL+*+K +L- KESE.ATA* A*AK KEPA*+TERAA* KL+*+K +L- KESE.ATA* A*AK
-*+/ERS
-*+/ERS+TAS KAT0L+K ++TAS KAT0L+K +*D0*ES+*D0*ES+A AA ATA 1AYTA 1AYAA PER+0DE $( AG-ST-S 2 $( SEPTE3ER "#$4 PER+0DE $( AG-ST-S 2 $( SEPTE3ER "#$4
KATA PE*GA*TAR
KATA PE*GA*TAR
Puji syukur saya
Puji syukur saya panjpanjatkan ke atkan ke hadihadirat Tuhan Yrat Tuhan Yanang g Maha Esa, Maha Esa, atas berkat dan atas berkat dan rahmarahmat-Nyt-Nya, a, saya dapatsaya dapat menyelesaikan referat yang berjudul Gangguan Keseimbangan pada Lansia
menyelesaikan referat yang berjudul Gangguan Keseimbangan pada Lansia
Penulisan karya tulis studi pustaka ini bertujuan untuk memberikan suatu gambaran tentang gangguan Penulisan karya tulis studi pustaka ini bertujuan untuk memberikan suatu gambaran tentang gangguan keseimbangan yang dapat terjadi pada lansia Gangguan keseimbangan merupakan salah satu penyakit keseimbangan yang dapat terjadi pada lansia Gangguan keseimbangan merupakan salah satu penyakit
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yang sering diderita !leh lansia
yang sering diderita !leh lansia dan meningkatkan m!rbiditas seperti jatuh pada dan meningkatkan m!rbiditas seperti jatuh pada lansialansia
Pada kesempatan ini, saya menyampaikan u"apan terima kasih kepada #r dr Yuda Turana, $p$ selaku Pada kesempatan ini, saya menyampaikan u"apan terima kasih kepada #r dr Yuda Turana, $p$ selaku pembimbing pada penu
pembimbing pada penulisan referat inilisan referat ini
Tentunya saya sadar masih banyak kekurangan dalam karya tulis yang saya susun ini %leh karena itu Tentunya saya sadar masih banyak kekurangan dalam karya tulis yang saya susun ini %leh karena itu kritik, saran, dan masukan bagi kemajuan
kritik, saran, dan masukan bagi kemajuan karya tulis saya ini sangat dihargai $aya terbuka bagi kritik dankarya tulis saya ini sangat dihargai $aya terbuka bagi kritik dan saran yang sifatnya membangun, demi penyempurnaan karya tulis ini $em!ga karya tulis ini dapat saran yang sifatnya membangun, demi penyempurnaan karya tulis ini $em!ga karya tulis ini dapat bermanfaat bagi kita sem
bermanfaat bagi kita semuaua
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"6
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Gangguan keseimbangan merupakan gangguan yang sering terjadi
Gangguan keseimbangan merupakan gangguan yang sering terjadi pada pasien lansia danpada pasien lansia dan berk!ntribusi terhadap
berk!ntribusi terhadap risik! jatuh risik! jatuh dan "idera dan "idera pada pada pasien lansiapasien lansia'' $ebanyak tujuh belas persen $ebanyak tujuh belas persen
penyebab jatuh pada pas
penyebab jatuh pada pasien lansia diakibatkien lansia diakibatkan adanya gangguan keseiman adanya gangguan keseimbanganbangan))
Keseimbangan adalah keadaan untuk mempertahankan ekuilibrium baik statis maupun Keseimbangan adalah keadaan untuk mempertahankan ekuilibrium baik statis maupun dinam
dinamis is ketiketika ka tubutubuh h dilediletakan dalam takan dalam berbaberbagai gai p!sip!sisi si KeseKeseimbanimbangan gan adalaadalah h sebuasebuah h bagiabagiann penting
penting dari dari pergerakan pergerakan tubuh tubuh dalam dalam menjaga menjaga tubuh tubuh tetap tetap stabil stabil sehingga sehingga tubuh tubuh tidak tidak jatuhjatuh 6alaupun tubuh berubah p!sisi Kesimbangan memerlukan input dari sistem 1isual, 1estibular, 6alaupun tubuh berubah p!sisi Kesimbangan memerlukan input dari sistem 1isual, 1estibular, dan
dan sistem pr!pri!septisistem pr!pri!septif 7nput tersebut akan di!lah df 7nput tersebut akan di!lah di !tak %tak akan meng!lah inf!i !tak %tak akan meng!lah inf!rmasi darirmasi dari sistem sens!ris tersebetu dan memberikan !utput m!t!rik
sistem sens!ris tersebetu dan memberikan !utput m!t!rik untuk menjaga keseimbangan tubuhuntuk menjaga keseimbangan tubuh,*,*
Lansia rentan terkena penyakit-penyakit yang mengenai penyakit degeneratif pada sistem Lansia rentan terkena penyakit-penyakit yang mengenai penyakit degeneratif pada sistem 1isual, pr!pri!septif, dan 1estibular Lansia juga mengalami penurunan fungsi
1isual, pr!pri!septif, dan 1estibular Lansia juga mengalami penurunan fungsi pada kekutan, !t!t,pada kekutan, !t!t, sta
stabibilitlitas as sensendidi, , dan dan keskesehaehatan tan kakkaki i yanyang g berberfunfungsgsi i sebsebagaagai i sisitem tem m!m!t!rt!rik ik yanyang g menmenjagjagaa kesimbangan Penurunan fungsi !tak sebagi pusat pengatu keseimbangan juga ditemukan pada kesimbangan Penurunan fungsi !tak sebagi pusat pengatu keseimbangan juga ditemukan pada lansia
lansia33
Gangg
Gangguan keseimuan keseimbangabangan menimbuln menimbulkan m!rbidkan m!rbiditas yang tinggitas yang tinggi pada lansia i pada lansia 8ntu8ntuk k mengurangi m!rbiditas jatu pada pasien lansia, harus dilakukan skrining mengenai gangguan mengurangi m!rbiditas jatu pada pasien lansia, harus dilakukan skrining mengenai gangguan keseimbangan pada lansia, sehingga diperlukan pengetahuan yang
keseimbangan pada lansia, sehingga diperlukan pengetahuan yang memadai mengengai gangguanmemadai mengengai gangguan keseimbangan pada lansia
keseimbangan pada lansia
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pada lansia:
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' Mengetahui anat!mi dan fisi!l!gi alat keseimbangan tubuhMengetahui anat!mi dan fisi!l!gi alat keseimbangan tubuh )
) Mengetahui penyebab gangguan keseimbangan pada lansiaMengetahui penyebab gangguan keseimbangan pada lansia
Mengetahui e1aluasi klinis gangguan keseimbangan pada lansiaMengetahui e1aluasi klinis gangguan keseimbangan pada lansia *
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3A3 ++
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pr!pri!septif
pr!pri!septif ;s!mat!sens!ri<, ;s!mat!sens!ri<, dan dan sistem sistem 1isual 1isual serta serta integrasinya integrasinya di di batang batang !tak !tak dandan serebelum
serebelum,*,*
Gambar' Pr!ses fisi!l!gis keseimbangan Gambar' Pr!ses fisi!l!gis keseimbangan )
)'''' $i$iststem /eem /eststibibulular ar )
)'''''' $i$iststem em 1e1eststibibulular ar peperirifefer r $istem 1estib
$istem 1estibular perifer terdapat di ular perifer terdapat di telintelinga ga tengah dan tengah dan dalamdalam, , terditerdiriri dari tulang dan membrane labirin, juga termasuk di dalamnya sel rambut ; dari tulang dan membrane labirin, juga termasuk di dalamnya sel rambut ;hair hair cells
cells< yang berfungsi sebagai sens!r gerakan dari sistem 1estibular< yang berfungsi sebagai sens!r gerakan dari sistem 1estibular Tulang labirin teridiri dari tiga kanalis semisirkularis ;
Tulang labirin teridiri dari tiga kanalis semisirkularis ; semicircul semicircular ar canal
canal = $>><, k!klea, dan 1estibulum Ketiga $>> berada pada bidang yang = $>><, k!klea, dan 1estibulum Ketiga $>> berada pada bidang yang berbeda
berbeda $>> lateral $>> lateral terletak pada terletak pada bidang bidang h!ri?!ntal, dan h!ri?!ntal, dan kedua kedua $>> lainnya$>> lainnya tegak lurus terhadap $>> lateral dan tegak lurus satu sama lain Tiap $>> tegak lurus terhadap $>> lateral dan tegak lurus satu sama lain Tiap $>> melebar pada satu ujungnya yang disebut ampula, di mana terdapat !rgan melebar pada satu ujungnya yang disebut ampula, di mana terdapat !rgan res
reseptept!r !r KriKrista sta ampampularularis is TuTulanlang g lablabiriirin n penpenuh uh "ai"airan ran perperililimfimfatiatik k yanyangg k!m
k!mp!p!sisisisinya nya sasama ma dendengagan n "ai"airaran n sesererebrbr!s!spipinalnal >a>airiran an peperirililimfmfatatik ik berhubungan dengan "airan serebr!spinal melalui akuaduktus k!klea
berhubungan dengan "airan serebr!spinal melalui akuaduktus k!klea
Membran labirin melekat di dalam tulang labirin !leh jaringan ikat Membran labirin melekat di dalam tulang labirin !leh jaringan ikat
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penunjang Maku
penunjang Makula berada la berada 1ertikal pada 1ertikal pada sakular dan sakular dan h!ri?!ntal pada h!ri?!ntal pada utrikulusutrikulus saat kepala dalam keadaan tegak Membran labirin berisi "airan end!limfatik saat kepala dalam keadaan tegak Membran labirin berisi "airan end!limfatik yang menyerupai "airan intraselular ;berhubungan dengan duktus k!klea< dan yang menyerupai "airan intraselular ;berhubungan dengan duktus k!klea< dan dikeli
dikelilingi !leh lingi !leh perilperilimfatimfatik ik dalam tulang dalam tulang labirlabirin in ;berh;berhubungan dengan ubungan dengan skalaskala 1estibule dan skala timpani k!klea<
1estibule dan skala timpani k!klea<,2,4,2,4
Gambar ) Tulang dan Membran
Gambar ) Tulang dan Membran labirinlabirin $el-se
$el-sel rambut khusus terdapat pada l rambut khusus terdapat pada tiap ampula dan tiap ampula dan !rgan !t!lit!rgan !t!lit $el$el ra
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jumlah
jumlah impuls impuls pada pada ner1us ner1us 1estibularis 1estibularis akan akan meningkat meningkat atau atau menurunmenurun $ehubungan dengan sudut gerakan kepala, tekanan end!limfe menyebabkan $ehubungan dengan sudut gerakan kepala, tekanan end!limfe menyebabkan kupula membengk!k ke depan dan belakan, menstimulasi sel-sel rambut kupula membengk!k ke depan dan belakan, menstimulasi sel-sel rambut
Membran !t!lit adalah struktur yang serupa dengan kupula namun Membran !t!lit adalah struktur yang serupa dengan kupula namun lebih berat, mengandung Kristal kalsium karb!nat yang
lebih berat, mengandung Kristal kalsium karb!nat yang disebdisebut ut !t!k!ni!t!k!niaa %t!
%t!k!nk!nia ia memmembuat buat memmembran bran !t!!t!litlitil il leblebih ih berberat at dardari i strstruktuktur ur seksekitaitarnyrnyaa sehingga menyebabkan makula sensiti1e terhadap gra1itasi dan akeselerasi sehingga menyebabkan makula sensiti1e terhadap gra1itasi dan akeselerasi linier $ebaliknya kupula mempunyai kepadatan yang serupa dengan "airan linier $ebaliknya kupula mempunyai kepadatan yang serupa dengan "airan end!limfatik sekitar dan tidak sensiti1e terhadap gra1itasi
end!limfatik sekitar dan tidak sensiti1e terhadap gra1itasi,2,4,2,4
Gambar >rista dan ampula Gambar >rista dan ampula $el
$el-se-sel l ramrambut but dardari i kanakanalilis s dan dan !t!l!t!lit it menmengubagubah h enerenergy gy mekmekanianiss gerakan kepala menjadi impuls neural ke area-area spesifik di batang !tak dan gerakan kepala menjadi impuls neural ke area-area spesifik di batang !tak dan serebelum Kanalis beresp!ns terhadap ke"epatan angular=r!tasi!nal dan !t!lit serebelum Kanalis beresp!ns terhadap ke"epatan angular=r!tasi!nal dan !t!lit
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Gambar * Membran !t!lit Gambar * Membran !t!lit
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Gambar 3 Kanalis semisirkularis Gambar 3 Kanalis semisirkularis
$erabut ner1us 1estibularis adalah pr!yeksi aferen dari neuran bip!lar $erabut ner1us 1estibularis adalah pr!yeksi aferen dari neuran bip!lar gang
gangli!li!n n 1es1estitibulabularis ris ;s";s"arparpa< a< yanyang g terterletletak ak di di kanakanalis lis audaudit!it!rik rik intinternernalal ;;interinternal nal auditauditoric oric canal canal =7><=7>< Ner1uNer1us s 1esti1estibularibularis s menyammenyampaikan paikan sinysinyalal aferen dari labirin ke 7> Pada 7>, ner1us 1estibularis bergabung dengan aferen dari labirin ke 7> Pada 7>, ner1us 1estibularis bergabung dengan ner1us k!klearis, ner1us fasilais, ner1us intermedius dan arteri labirintin 7> ner1us k!klearis, ner1us fasilais, ner1us intermedius dan arteri labirintin 7> berjalan
berjalan melalui melalui bagian bagian petr!us petr!us tulang tulang temp!ral temp!ral sampai sampai ke ke f!ssa f!ssa p!steri!r p!steri!r setingkat dengan p!ns, kemudian berjalan menyebrangi ruang subara"hn!id setingkat dengan p!ns, kemudian berjalan menyebrangi ruang subara"hn!id memasuki batang !tak pada sudut p!nt!medularis, dan selanjutnya menuju ke memasuki batang !tak pada sudut p!nt!medularis, dan selanjutnya menuju ke nu"leus 1estibularis pada dasar 1entrikel empat
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5efle@ 1estibul!-!kular ;/%5< merupakan mekanisme untuk menghasilkan 5efle@ 1estibul!-!kular ;/%5< merupakan mekanisme untuk menghasilkan gerak
gerakan an mata mela6an gerakan kepala, mata mela6an gerakan kepala, memunmemungkingkinkankan gaze gaze untuk tetap terfiksasiuntuk tetap terfiksasi pada titik
pada titik tertentu Pr!yeksi desending tertentu Pr!yeksi desending nu"leus 1estibular penting untuk nu"leus 1estibular penting untuk penyesuaianpenyesuaian kepala yang dimediasi !leh refle@ 1estibul!-ser1ikal ;/>5< dan penyesuaian tubuh kepala yang dimediasi !leh refle@ 1estibul!-ser1ikal ;/>5< dan penyesuaian tubuh yang dimediasi !leh refle@
yang dimediasi !leh refle@ 1estibul!-spi1estibul!-spinal ;/$5< &alur nal ;/$5< &alur />5 mengatur p!sisi kepala/>5 mengatur p!sisi kepala dengan akti1itas reflleks !t!t-!t!t leher sebagai resp!n stimulasi dari $>> terhadap dengan akti1itas reflleks !t!t-!t!t leher sebagai resp!n stimulasi dari $>> terhadap akselerasi r!tasi!nal kepala /$5 mengakti1asi kel!mp!k neur!n m!t!rik ipsilateral akselerasi r!tasi!nal kepala /$5 mengakti1asi kel!mp!k neur!n m!t!rik ipsilateral yang menginer1asi
yang menginer1asi !t!t-!t!t eks!t!t-!t!t ekstens!r rangka dan tens!r rangka dan angg!ta gerak angg!ta gerak untuk memediasiuntuk memediasi keseimbangan dan mempertahankan p!stur yang tegak
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1estibular sentral bila perlu Pada kedua tempat
1estibular sentral bila perlu Pada kedua tempat tempat tersebut, input sens!rik tempat tersebut, input sens!rik 1estibular dipr!ses dengan input s!mat!sens!rik dan 1isual
1estibular dipr!ses dengan input s!mat!sens!rik dan 1isual4,B,04,B,0
Gambar 4 &aras 1estibular sentral Gambar 4 &aras 1estibular sentral Nu"leus
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terjadi di sekitar dan member inf!rmasi langsung ke !tak, kemudian !tak memeri terjadi di sekitar dan member inf!rmasi langsung ke !tak, kemudian !tak memeri inf
inf!rm!rmasi asi agaagar r sissistem tem musmus"ul"ul!sk!skeleeletal tal dapdapat at bekbekerjerja a se"se"ara ara sinsinergergis is untuntuk uk mempertahankan keseimbangan tubuh
mempertahankan keseimbangan tubuh'('(
))
))
PEN
PENYE+
YE++ G
+ GNG
NGG8
G8N KE
N KE$E7M
$E7M+N
+NGN
GN P
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# LN
LN$7
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Gangguan keseimbangan ;
Gangguan keseimbangan ;dizzinessdizziness< timbul apabilah terdapat gangguan pada alat< timbul apabilah terdapat gangguan pada alat ke
keseseimimbabangngan an MaManinifefeststasasi i kliklininis s dardarii dizzinessdizziness teterdrdapapat at titiga ga jejeninis s yayaititu u 1e1ertrtigig!,!, presink!p,
presink!p, dandan disequilibriumdisequilibrium /ertig! ditandai dengan gejala rasa berputar Presink!p /ertig! ditandai dengan gejala rasa berputar Presink!p adalah rasa mau
adalah rasa mau pingspingsan akibat gangguan kardi!1asan akibat gangguan kardi!1askularkular Disequilibrium Disequilibrium berupa berupa rasarasa g!yah tidak stabil sehingga terasa akan jatuh
g!yah tidak stabil sehingga terasa akan jatuh''''
Pada lansia terdapat berbagai penyakit yang akibat usia lanjut pada !rgan yang Pada lansia terdapat berbagai penyakit yang akibat usia lanjut pada !rgan yang berperan pada keseimbangan seperti pen
berperan pada keseimbangan seperti penyakit pada sistem 1isual yaitu katarak, glau"!ma,yakit pada sistem 1isual yaitu katarak, glau"!ma, retin!pati diabetik, degenerasi ma"ularC neur!pati diabetika yang mengganggu impuls retin!pati diabetik, degenerasi ma"ularC neur!pati diabetika yang mengganggu impuls kaki dan tungkaiC serta degenerasi sistem 1estibular Keseimbangan juga bergantung pada kaki dan tungkaiC serta degenerasi sistem 1estibular Keseimbangan juga bergantung pada keku
kekuataatan n musmuskulkul!sk!skeleeletaltal, , dan dan m!bm!biliilisassasi i sensendi di PenyPenyakiakit t artartritritis, is, kelkelainainan an !t!t !t!t dandan tulang akan mempengaruhi m!bilistas dan kekuatan mempertahankan p!stural
tulang akan mempengaruhi m!bilistas dan kekuatan mempertahankan p!stural33
Per
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)
)))'' //eertrtiig!g! /e
/ertig! adalah persepsi yang rtig! adalah persepsi yang salah dari gerakan sese!rang salah dari gerakan sese!rang atau lingkunganatau lingkungan sekitarnya Terdapat dua jenis 1ertig!A
sekitarnya Terdapat dua jenis 1ertig!A '
' //eertrtigig! ! 1e1eststibibulular ar memeninimbmbululkakan n sesensnsasasi i beberprpututarar, , titimbmbul ul epepisis!d!di"i",, dipr!1!kasi gerakan kepala, dan dapat disertai rasa mual muntah
dipr!1!kasi gerakan kepala, dan dapat disertai rasa mual muntah )
) //eertirtig! g! n!nn!n-1e-1estistibulbular ar menmenimimbulkbulkan an rarasa sa melmelayanayang, g, g!yg!yang, ang, berberlanlangsugsungng k!ns
k!nstantan, , tidtidak ak disdisertertai ai muamual l munmuntahtah, , serserangaangan n disdisebaebabkan bkan gergerakaakan n !bje!bjek k 1is
1isual ual seksekitaitar r sepseperterti i temtempat pat kerkeramaamaianian, , ataatau u lallalu u linlintas tas ma"ma"et et PenyPenyebabebab 1ertig! n!n-1estibular antara lain p!lineur!pati, miel!pati, artr!sis ser1ikal, 1ertig! n!n-1estibular antara lain p!lineur!pati, miel!pati, artr!sis ser1ikal, tr
trauauma ma leleheherr, , hihip!p!tetensnsi i !r!rt!t!ststatatikik, , hihipeper1r1enentitilalasisi,, tetensnsioion n heaheadadacheche,, hip!glikemi, dan penyakit sistemik
hip!glikemi, dan penyakit sistemik
/ertig! 1estibular terdiri dari dua jenis yaitu sentral dan perifer /ertig! /ertig! 1estibular terdiri dari dua jenis yaitu sentral dan perifer /ertig! 1estibular perifer timbul lebih mendadak setelah perubahan p!sisi kepala, dengan 1estibular perifer timbul lebih mendadak setelah perubahan p!sisi kepala, dengan rasa berputar yang berat, disertai mual muntah dan berkeringat #apat diertai rasa berputar yang berat, disertai mual muntah dan berkeringat #apat diertai gangguan pendengaran seperti tinnitus atau ketulian, dan tidak disertai gejala gangguan pendengaran seperti tinnitus atau ketulian, dan tidak disertai gejala neur
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fragmen !t!k!nia yang terlepas pada permukaan kupula kanalis semisirkularis fragmen !t!k!nia yang terlepas pada permukaan kupula kanalis semisirkularis p!rteri!r
p!rteri!r Pada Pada pasien pasien lansia lansia diduga diduga berkaitan berkaitan dengan dengan timbulnya timbulnya !ste!penia !ste!penia dandan !s
!stete!p!p!r!r!s!sis is sesehihingngga ga dedebrbris is mumudadah h teterlrlepaepas s dan dan memeninimbmbululkakan n seserarangnganan berulang
berulang $edangkan $edangkan hip!tesis hip!tesis kanalitiasis kanalitiasis menyatakan menyatakan bah6a bah6a kristal kristal kalsiumkalsium karb!nat bergerak
karb!nat bergerak di di dalam kanalis dalam kanalis semisemisirkulsirkularis aris ;kanal;kanalitiaitiasis< menyebabkansis< menyebabkan en
end!d!lilimfmfe e bebergrgererak ak dadan n memensnstitimumulalasi si amampupula la dadalalam m kakananal, l, sesehihingnggaga menyebabkan 1ertig!
menyebabkan 1ertig! Gam
Gambarabaran n kliklinis nis yanyang g munmun"ul "ul adaladalah ah 1er1ertitig! g! timtimbul bul menmendadadadak k padapada perubahan
perubahan p!sisi p!sisi seperti seperti miring miring pada pada satu satu sisi sisi saat saat berbaring, berbaring, bangkit bangkit dari dari tidur,tidur, membungkuk, menunduk, atau menengadah $erangan berlangsung singkat '(-( membungkuk, menunduk, atau menengadah $erangan berlangsung singkat '(-( detik +isa disertai mual muntah $etelah rasa berputar menghilang, pasien merasa detik +isa disertai mual muntah $etelah rasa berputar menghilang, pasien merasa melayang dan diikuti disekuilbrium selama bebera!a h
melayang dan diikuti disekuilbrium selama bebera!a h ari sampai mingguari sampai minggu''
#iagn!sis A #iagn!sis A '
' namnamnesnesis A is A 1er1ertitig! g! terterasa berpasa berputautar, timr, timbul mendabul mendadak pada perubadak pada perubahan p!sishan p!sisii kepala atau badan, lamanya D( detik, dapat disertai mual dan muntah
kepala atau badan, lamanya D( detik, dapat disertai mual dan muntah )
) PemPemerieriksaksaan fisian fisik k A A padpada a yanyang g idiidi!pat!patik tidak diteik tidak ditemukmukan kelaian kelainan, sedanan, sedangkngkanan yang simpt!matik dapat ditemukan kelainan ne
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'
' K!K!mumuninikakasi si dadan n ininf!f!rmrmasasi i A A +P+PP/ P/ bubukakan n sesesusuatatu u yayang ng beberbrbahahayaya a dadann pr!gn!sis
pr!gn!sis baik, baik, dapat dapat hilang hilang sp!ntan sp!ntan dalam dalam beberapa beberapa 6aktu, 6aktu, 6alaupun6alaupun kadang-kadang dapat berlangsung lama dan se6aktu-6aktu dapat kambuh kadang-kadang dapat berlangsung lama dan se6aktu-6aktu dapat kambuh kembali
kembali )
) Medika mMedika ment!sa A ent!sa A !bat ant!bat anti1erti1ertig! serig! seringkalingkali tidak i tidak diperldiperlukan, namukan, namun apabilun apabilaa ter
terjadjadi i disdisekuiekuiliblibriurium m paspas"a "a +PP+PP//, , pempemberiberian an betbetahiahististin n berbergunguna a untuntuk uk memper"epat k!mpensasi
memper"epat k!mpensasi
TeTeraprapi +i +PP/ PP/ kanakanal pl p!st!sterieri!r!r a
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Peny
Penyakit akit menimeniere ere adaladalah ah sessesuatuatu u gangganguan uan kr!kr!nis nis teltelinginga a daldalam am yangyang ditandai dengan epis!de 1ertig! disertai tuli sens!rinerual, tinnitus, dan sensasi ditandai dengan epis!de 1ertig! disertai tuli sens!rinerual, tinnitus, dan sensasi tekanan pada telinga Eti!l!gi pasti penyakit ini belum dimengerti sepenuhnya tekanan pada telinga Eti!l!gi pasti penyakit ini belum dimengerti sepenuhnya Pene
Penemuamuan n hishist!pt!pat!at!l!gil!gis s utautama ma pada pada penypenyakiakit t ini ini adaladalah ah penipeningkangkatan tan "air"airanan end!lime pada telinga dalam yang dapat disebabkan !leh pr!duksi berlebih atau end!lime pada telinga dalam yang dapat disebabkan !leh pr!duksi berlebih atau menuru
menurunnya nnya drainadrainase se end!liend!limfe mfe sehinsehingga gga terjaterjadi di peningkpeningkatan atan tekanatekanan n telintelingaga dalam Kelainan anat!mis baik "!ngenital maupun akuisata dapat mengganggu dalam Kelainan anat!mis baik "!ngenital maupun akuisata dapat mengganggu aliran end!limfe
aliran end!limfe $elain itu $elain itu gangguan 1askularisasi gangguan 1askularisasi juga disebut sjuga disebut sebagai eti!l!giebagai eti!l!gi penyakit
penyakit Meniere Meniere 7nfeksi 7nfeksi 1irus 1irus dan dan fakt!r fakt!r imun!l!gis imun!l!gis juga juga diakukan diakukan sebagaisebagai penyebab penyakit Meniere
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-- #iu#iuretretik A 9yik A 9ydr!dr!"hl"hl!rt!rthia?hia?ideide=as=asetaetas!ls!lamiamid 3(md 3(mg=hg=hariari
-- $t$terer!i!id d A A PrPrededninis!s!ne ne B(B(mmg=g=hahari ri seselalama ma 4 4 hahari ri kekemumudidian an diditutururunknkanan bertahap
bertahap -- KK>>ll
-- nnttiihhiissttaammiinn )
) ##iieett
-- 5e5endndah gah gararam ;am ;',',3-3-) gr) gram sam seheharari<i< -- TTiingnggi kgi kalaliuium, tm, tininggggi pri pr!t!teieinn
-- 99iiddrraassii 9in
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!ksipitalis, hiperdensitas arteri basilar ngi!grafi digunakan sebagai p
!ksipitalis, hiperdensitas arteri basilar ngi!grafi digunakan sebagai p emeriksaanemeriksaan lanjutan untuk mengidentifikasi pembuluh darah yang !klusi
lanjutan untuk mengidentifikasi pembuluh darah yang !klusi
Penanganan str!ke 1ertebr!basilar sama seperti penangan str!ke lainnya Penanganan str!ke 1ertebr!basilar sama seperti penangan str!ke lainnya di
disesesusuaiaikan kan dedengangan n patpat!f!fisisi!i!l!l!gi gi pepenynyebaebab b ststr!r!keke PerPera6a6atatan an daldalam am 7>7>88 diindikasikan untuk pasien yang merupakan kandidat untuk terapi inter1ensi!nal diindikasikan untuk pasien yang merupakan kandidat untuk terapi inter1ensi!nal sepert
seperti i thr!mthr!mb!lisb!lisis, is, atau atau pasiepasien n yang yang mengalmengalami ami gejalgejala a neur!lneur!l!gis !gis fluktfluktuatifuatif,, penurunan
penurunan kesadaranm kesadaranm instabilitas instabilitas hem!dinamik, hem!dinamik, atau atau disertai disertai dengan dengan masalahmasalah kardi!pulm!ner aktif
kardi!pulm!ner aktif')')
)
))))) PrPresesinink!k!pp
Presink!p merupakan perasaan akan hilang kesadaran atau mau pingsan Presink!p merupakan perasaan akan hilang kesadaran atau mau pingsan
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*
* KarKardi!di!1as1askulakularA rA stesten!sn!sis is a!ra!rta, ta, karkardi!mdi!mi!pi!pati ati hiphipertertr!fr!fik, ik, pr!pr!laplaps s mitmitralral,, 1arises
1arises 3
3 PulPulm!A m!A PP%PP%K, hiK, hiperpertentensi psi pulmulm!nal!nal,, obstructive sleep apneaobstructive sleep apnea 2
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paling
paling sering sering adalah adalah defi"it defi"it multisens!ris multisens!ris 9al 9al ini ini ditandai ditandai dengan dengan penurunanpenurunan ketajam sistem sens!ris pada beberapa sistem seperti sensiti1itas pr!pri!septif ketajam sistem sens!ris pada beberapa sistem seperti sensiti1itas pr!pri!septif pada
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meng!ntr!l nyeri pada neur!pati diabetik antara lain pregabalin, gabapentin, asam meng!ntr!l nyeri pada neur!pati diabetik antara lain pregabalin, gabapentin, asam 1alpr!at, tramad!l
1alpr!at, tramad!l'B'B
22!2
22!2 Penyakit Parkins!nPenyakit Parkins!n
Penyakit Parkins!n adalah bagian dari parkins!nism yang se"ara pat!l!gi Penyakit Parkins!n adalah bagian dari parkins!nism yang se"ara pat!l!gi
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gangguan pada kedua sisi sehingga pasien mengalami kesulitan saat berjalan dengan gangguan pada kedua sisi sehingga pasien mengalami kesulitan saat berjalan dengan langkah besar Pasien "enderung berjalan dengan langkah ke"il "epat bahkan hingga langkah besar Pasien "enderung berjalan dengan langkah ke"il "epat bahkan hingga kesul
kesulitan untuk berhenti ketka itan untuk berhenti ketka berjberjalan Tealan Terdapa pulardapa pula freezing freezing episodeepisode pada penyakit pada penyakit stadium lanjut di mana pasien merasa kesulitan untuk mengambil langkah sama sekali stadium lanjut di mana pasien merasa kesulitan untuk mengambil langkah sama sekali
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Pemeriksaan fisik disesuaikan dengan hasil anamnesis Pemeriksaan fisik yang perlu dilakukan Pemeriksaan fisik disesuaikan dengan hasil anamnesis Pemeriksaan fisik yang perlu dilakukan pada pasien dengan geja
pada pasien dengan gejala gangguan keseimla gangguan keseimbangan antara lainAbangan antara lainA'2,'4'2,'4
•
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