Failure of Gan CRM Overcome by Successful Semont Manoeuvre in BPPV Post Head Trauma: A Case Study

Z. Zainun, Muhammad Munzir Zuber Ahmadi, J. Abdullah, Nur Syakirah Bt Che Mat Amin
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Abstract

Objective: Benign paroxysmal positional vertigo (BPPV) is one of common peripheral vestibular problem reported that head injury is one of common cause among young age. In current situation it only treated by medication or injection by medical officer and specialist. Medication is not an optimal treatment and it only symptomatic therapy and often need chronic prescriptions if not treated properly. There are an optimum specific manoeuvre offers curative therapy in majority of BPPV cases such as Epley’s manoeuvre, Gan Canal repositioning Manoeuvrer (CRM) and Semont manoeuvre. Semont manoeuvre is one of selected manoeuvre that recently done in posterior BBPV case if Epley’s and Gan CRM failed, but less practice among our clinician due to less exposure. Case Studies: A 22 -year-old gentleman, complain of imbalance, difficulty in walking and vertigo for the past few days. He history of moderate traumatic brain injury (left parietooccipital Epidural Haemorrhage) and surgical intervention done last 5 days ago. He also complained of reduced hearing and on off left tinnitus over left side. No prominent psychological involvement reported. Detail physical and balance assessment done using BAL EX Foam test Modified Dix Hallpike Test (DHT) done. During the left DHT there is rotatory up beating nystagmus then it proceeds with GRM three-time, 1 session on previous day and 2 session on the current day but it was failed. Then proceed with Semont manoeuvre by specialist in vestibular rehabilitation. After 10 minutes of manoeuvre, modified DHT done and show negative result found there is no nystagmus.
头部创伤后BPPV手术成功克服Gan CRM失败:一个案例研究
目的:良性阵发性位置性眩晕(BPPV)是一种常见的外周前庭疾病,报道头部损伤是青少年中常见的原因之一。在目前的情况下,只能由医务人员和专家通过药物或注射进行治疗。药物治疗不是最佳的治疗方法,它只是对症治疗,如果治疗不当,往往需要长期处方。在大多数BPPV病例中,有一种最佳的特定手法可提供治疗,如Epley手法、Gan管复位手法(CRM)和Semont手法。Semont手法是最近在Epley 's和Gan CRM失败的后侧BBPV病例中选择的手法之一,但由于暴露较少,临床医生的实践较少。案例研究:一位22岁的男士,在过去的几天里抱怨身体不平衡,行走困难和眩晕。中度外伤性脑损伤(左顶骨硬膜外出血)病史,5天前接受手术治疗。他还抱怨听力下降,左侧耳鸣断断续续。没有明显的心理影响报告。详细的物理和平衡评估使用BAL EX泡沫测试修改Dix Hallpike测试(DHT)完成。在左DHT期间有旋转上跳动的眼球震颤然后进行三次GRM,前一天1次,今天2次,但失败了。然后由前庭康复专家进行Semont手法。操作10分钟后行改良DHT,结果阴性,无眼球震颤。
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