a case of cerebro vascular accident (cva)

8/16/2019 A Case of Cerebro Vascular Accident (CVA)

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This is the case of a male, 50 years of age, who presented atthe Palghar Hospital OPD on 20th August ’05 withtinglingnum!ness of the upper and lower lim!s on the leftside" This had !egun #0 days earlier and was progressi$ely getting worse" %t !egan with wea&ness of the lim!s on the leftside and he was now una!le to mo$e them" An episode of se$ere an'iety and fear had precipitated this onset of symptoms" %t had progressed further and now he had slurredspeech and was laughing immoderately" He also had a strongfeeling of !eing into'icated ((" Along with this there had !eena recurrent headache that tended to !e worse in the morning,around )*#0 am"

2 months earlier he had de$eloped hypertension" Thesymptoms at that point were a similar tingling and num!nesson the left upper and lower lim!s" This too, was precipitated !y an episode of fear" He was put on anti hypertensi$emedication which helped and he stopped this on his own aftera while"

There were no other +- symptoms of unconsciousness,pro.ectile $omiting, con$ulsions, fe$er or head in.ury"

There was no Past History of dia!etes, or ischemic heartdisease as possi!le precipitating factors"

On /'amination

Pulse 1min

3P #50#004- +lear

+- -#-2 ormal

PA AD

+- +onscious, +ooperati$e, 6ell oriented in time, space and person


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Higher 7unctions, +ranial er$es ormal

o Palliloedema

Motor Right Left

Tone: UL Normal Increased ++

Tone : LL Normal Increased ++

Muscle Power: UL Normal Proximal Muscles:

Power 1/ !istal

Muscles: Power "/

Muscle Power: LL Normal #om$lete loss of

$ower: %/

Re&exes: UL Normal '($ertonic ++

Re&exes: LL Normal '($ertonic ++

)ensor( Normal Loss of *ne touch in

U$$er and Lower

lims

At this point in the OPD we had to decide whether this case

needed to !e admitted as inpatient for homeopathicmanagement" 6e follow a set of criteria to ma&e this decisionfor all cases, including this one" Here are the criteria thatindicate mandatory in*patient admission for a homeopathicpatient"

• Close monitoring for a potentially fatal illness

• Observation for developing complications.

• Detailed investigation of the acute condition and risk factors.

• Homoeopathic remedy reaction

• Ancillary measure – physiotherapy

%n this case, hospital admission was a necessity for furtherin$estigations and management to !e carried out"

%n$estigations• Hb : 15.2


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• T.L.C.: 7800 N 68 E 0 B 0 L 26 M2

• RBS : 65.2

• B .U. N. :9.0

• S. CHOLESTROL : 300.2

• S . TRIGLYCERIDES : 254

•

S. CREAT : 1.0/"+"8" 9""H" Pattern

+T -+A : 34A% ;Pictures can !e $iewed in the attachedslide presentation<

/o ill*defined hypodense lesion seen in the 4t high parietallo!e in$ol$ing centrum semi o$ale, mostly suggesti$e of recentnon*hemorrhagic infarct in 4t =+A area"

/o multiple lacunar infarcts in 4t internal capsule > !asalganglia"

/o old small si?e infarct in 9t anterior lim! of internalcapsule in 9t =+A area" Peri$entricular white matter ischemicchanges seen"

FINAL DIAGNOSIS:9T -%D/D H/=%P9/8%A, secondary to 4ight =+A ;=iddle+ere!ral Artery< non*hemorrhagic infarct in$ol$ing theparietal lo!e of the cere!rum"

H@P/4T/-%O

H@P/49%P%DA/=%A

Management:Once these preliminary medical o!ser$ations are complete, we must now appraoch the case from the homeopathicstandpoint for appropriate homeopathic management andcare" %n fact the homeopathic diagnosis is an integrated


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ongoing process e$en through the medical wor& !eing donea!o$e"

6hat is o!$ious from a!o$e, is that there already e'ists a

chronic process going on o$er many months that hasprecipitated now as a hemiplagia ;stro&e


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These were the ru!rics chosen" Our ne't step was to consider which repertori?ation approach was appropriate to this casegi$en the characteristic picture" -ince there was characteristicsensation, modalities, concomitants, and causation, we chosethe 3oenninghausan’s approach for repertori?ation"

The remedies that came up were Nux Moschata, Gelsemium, Opium, Rhus tox ,Causticum"7urthur discussion was reuired to decide on the appropriateremedy"

Along with this we also made an assessment of

the Susceptiblity • S!"#$%&b&'&%(: L)* S#+!&%&,&%(: H&-

• /"#: S')*

• C"%#&!%&": #*

• /%)')-(: S%"%' I#,#!&b'#

• &%' )-+ #"%#

Hence the choice of posology was 9ow potency with freuentrepetition"

The ne't step was to e$aluate the underlying Miasm• 10 ..

• SLO /ROGRESS

• CONUSION

• INTOICATED EELING

• IMMODERATE LAUGHTER

• STINESS

• HY/ERLI/DAEMIA

The miasm is -@+OT%+

The final choice of remedy was Gelsemium 3C!Follo" #p:

$%&'&(:• N) #"#; +) -&&+#!!;

• M&' +"' $&+.

• TINGLING NUMBNESS < 50=O>E:

• B/? 140>90


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• L%: U//ER LIMB @ LOER LIMB

Hypertonia((

Power : left shoulder 5 E ((

left hip F5

&nee > an&le 05

Plan +ontinue 8elsemium F0 GD-$3&'&(:

o T%89%8 C=3/--"

-ensation of tightness in left upper and lower lim!s E 5I

PO6/4 -A=/

Plan Gelsemium 200 GD-$)&'&(:

O -C3J/+T%/ +O=P9A%T-

APP/T%T/, -9//P O4=A9

PO6/4 -A=/

The patient is now a!le to wal& with support" 3ut this support too is less that what he

reuired earlier"

Plan To !e Discharged and follow up in OPD regularly"

+ontinue Gelsemium #= GD-"


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At this stage we also considered the +hronic totality for asimilimum so as to !e a!le to appropriately !egin with chronic

treatment when clinically indicated" Here is the chronicpicture

*+e patient as a person:• H# ! 5 -%#! *) # '),#! ,#( ".

• O '' %#!#; &! 3 -%#! !&%%&)+ *) & %# )!%. T&!

-%#! !b+ *! '"))'&" + ''#-#'( &''# &! &!% *&# &+

+#+ -#.

• H#+"# %# $%+% #&+# ")+!%+%'( &+ %)" *&% %&! -%# )+ %#

$)+#. H# #&+# %##+)!'( +&)! b)% #.

• 2 )+%! -) *#+ %# ($#%#+!&,# #$&!)# $#"&$&%%# # b##+

+b'# %) %' %) # )+ %# $)+#. N)% +)*&+- %# #!)+ ) %&!; &! -)% ,#(& + %)-% %% # !b+ &''# #. H&! B/ *#+% $ *&% %#

&+%#+!# +%( + # b#-+ %) ,# %&+-'&+- +b+#!! )+ &! '#% !&#.

• /#!#+%'( # %) &! #%#&)%&+- #'%; # #&+! ,#( +&)! b)% &!

-%#! %# # %) # '"))'&" !b+ + &! )*+ *&#! %#; ! #

& +)% ,# +( !)+!.

• H# *! ")+!"+%&)! + *)# &+ )# %) !$$)% &! '-# &'(

) -%#!.

• I+ &%&)+ # &! "&''(; ! ,#!&)+ ) !*##%!.

The Totality !ased on this information is

• ANIOUS

• INDUSTRIOUS

• SYM/ATHETIC

• SENTIMENTAL

• AERSION SEETS

• CHILLY

The constitutional remedy chosen was +austicum"

Follo" up:

$,!'!(On Gelsemium #=, his gait impro$ed further, there was no more tingling num!ness,

his 3P was #2010" 3ut the wea&ness in his muscle power remained the same"

He was now put on Causticum F0+, # single powder at !edtime"

%-!,!)

o into'icated feeling


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o headache

o Tingling um!ness

Power %mpro$ed

• L#% H&$: 3>5

• L#% +##: 1>5

• L#% S)'#: 4>5

Plan Causticum F0+, # dose power daily at !edtime for days"His power continued to impro$e and he was normal with !lood pressure well within control, an'iety considera!ly lessened" His lipid le$els also !egan to reduce in time" The

healing and resolution too& place o$er a period of .ust a few wee&s : which is remar&a!le in itself" That the patient choseto !egin homeopathic treatment right at the outset was animportant reason for such a uic& resolution, !efore any othermedication interfered with response of the $ital force to anappropriate simillimum"

This is a clear e'ample of how serious cases can !e managed

effecti$ely on homeopathic treatment and management without any need for allopathic inter$entions, pro$ided weha$e our principles of remedy choice and management clearly in place"

Than& you,Dr! Niran.an /ai, =edicine Part %% with Dr! Na0in /a0as1ar=edicine DepartmentDr" ="9" Dhawle =emorial Trust’s 4ural HomeopathicHospital,Opp -"T" 6or&shop, Palghar : 3oisar 4oad,


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Palghar 0# 0, =aharashtra, %ndiaPH ;02525< 25K)F2, 25K)FF

a case of cerebro vascular accident (cva)

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