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

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.