ABSTRAK
Insidensi terjadinya kasus BPPV di dunia mencapai 64/100.000 yang paling banyak melibatkan kanalis semisirkularis posterior unilateral. Lima puluh persen penyebabnya adalah idiopatik, diikuti dengan kasus trauma kepala, neuritis vestibularis, migrain, implantasi gigi dan mastoiditis kronis. Sebuah kasus pusing berputar disertai dengan mual dan muntah pada perempuan usia 49 tahun sejak 3 jam sebelum datang ke Puskesmas Rawat Inap Simpur. Pasien memiliki riwayat vertigo sejak 3 tahun lalu dan riwayat hipertensi sejak 1,5 tahun yang lalu. Pemeriksaan fisik didapatkan tekanan darah 150/90 mmHg dengan IMT 25,3 (pemeriksaan fisik lain dalam batas normal).Pemeriksaan neurologis otologi didaptkan hasil Dix-Hallpike maneuver vertigo positif dengan nistagmus cepat ke kiri. Dilakukan intervensi dengan pendekatan dokter keluarga berupa tindakan Epley manuver selama perawatan di puskesmas serta pemberian betahistin mesylate 3 x 6 mg, difenhidramin HCl 4 x 25 mg, dan kaptopril 1 x 12,5 mg. Saat pulang pasien diberikan edukasi mengenai latihan vestibuler berupa Brandt-Daroff maneuver dan pola hidup sehat. Dilakukan follow up pada pasien sebanyak 4 kali dan didapatkan hasil keluhan berkurang lebih dari 50% sejak datang ke puskesmas, pusing hanya terasa pada saat bangun dari tidur. Penatalaksanaan BPPV kanalis posterior kanan yang diberikan pada kasus ini sudah sesuai dengan guideline dan penelitian terkini, terlihat perkembangan yang baik pada gejala klinis dan perubahan perilaku pasien setelah dilakukan intervensi berdasarkan evidence based medicine yang bersifat patient centred dan family approach.
Kata Kunci: BPPV, Dokter Keluarga, Kanal Posterior Kanan, Unilateral
ABSTRACT
The incidence of Benign Paroxysmal Positional Vertigo (BPPV) has been reported 64/100.000 in the world which mostly involves the unilateral posterior semicircular canal. Fifty percent of the cases are idiopathic, followed by cases of head trauma, vestibular neuritis, migraine, dental implantation, and chronic mastoiditis. Case: A Dizziness, nausea, and vomiting in 49 years old woman who came to the Simpur Primary Health Care (PHC) have been reported. She appeared to be overweight with BMI is 25,3. Her physical examinations were normal except blood pressure is 150/90 mmHg and Dix-Hallpike vertigo positive maneuver with fast nystagmus to the left. Family medicine approach was carried out as holistic and comprehensive management by performing Epley maneuvers during treatment at the PHC and the administration 3 x 6 mg of betahistine mesylate, 4 x 25 mg of diphenhydramine HCl, and 1 x 12.5 mg of captopril. Brandt-Daroff maneuver and healthy lifestyle education were given to her before she came home. There were 4 times follow-ups for patient and the results of complaints were reduced by more than 50% since coming to the PHC, dizziness was only felt when she is waking up from sleep. The diagnosis and management were given to the patient are by the guidelines and current research, there is a good development in clinical symptoms and changes in patient behavior after patient-centered and family approach intervention based on “evidence-based medicine”.
Keywords: BPPV, Family Psychian, Right Posterior Channel, Unilateral
Developing an Integrated Evidence-Based Medicine Curriculum for Family Medicine Residency at the University of Alberta
