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  • 1. CEREBROVASCULAR ACCIDENTS HOMOEOPATHIC ANALYTICAL APPROACHDr.K.Ram Kumar M.D(Hom) Senior Medical Officer Directorate of AYUSH Govt of NCT of Delhi.

2. CEREBROVASCULAR ACCIDENTS STROKE(APOPLEXY)The rapid onset of focal neurological deficit, resulting from diseases of the Cerebral vasculature and its contents. 3. Diseases of the Cerebral blood vessels are the third most common cause of death next to Ischaemic Heart Disease and Cancer. Cerebrovascular disease can cause death and disability by; Ischemia from occlusion of blood vessels (producing Cerebral Ischaemia and Infarction.) Or Hemorrhage through their rupture. 4. GENERAL CLASSIFICATION Ischaemic variety; Cerebral Thrombosis Cerebral Embolism Hemorrhagic variety; Ruptured Aneurysm in the young Hypertensive Cerebral hemorrhage in the elderly Lacunar infarcts are deep, small multiple wedge-shaped cerebral infarcts. 5. RISK FACTORS MAJOR RISKS Arterial Hypertension Diabetes mellitus Smoking Hyperlipidaemia Polycythaemia, sickle cell anemia Thrombocythaemia Heart failure, Atrial fibrillation, Infective endocarditisMINOR RISKS High alcohol intake Positive family history Oral Contraceptives Trauma 6. CLINICAL CLASSIFICATION Complete, if the focal neurological deficit is persistent and not worsening. Transient (TIA) if the focal neurological deficit recovers within 24 hours. Evolving if the focal neurological deficit continues to worsen after about 6 hours from onset. 7. HOMOEOPATHIC THERAPEUTICAL APPROACH 8. THE GOALS OF THERAPY TO AVOID DEVELOPMENTOF CEREBRAL INFARCTIONAND IF, PRESENT ALREADY TO PREVENT ITS PROGRSSION OR RECCURENCE 9. THERAPEUTICS Based on; Mode of onset of the disease & Aetiology Anatomical Site Of lesions Stage of the disease 10. COMMONLY INDICATED REMEDIES ACONITE ARNICA AGARICUS ALUMINA AURUM BARYTA-C BARYTA-M BELLADONA BOTHROPS CALC-C CALC-F CAUSTICUM COCCULUSCROT-HOR CROT-CASC GELSEMIUM GLONOINE IPECAC LACHESIS NUX-VOM NUX-MOS OPIUM PHOSPHORUS PLUMBUM VERAT-VIR ZINCUM 11. MODE OF ONSET & AETIOLOGY RAPID ONSET STROKE CEREBRAL THROMBOSIS a) Atherosclerosis Baryta-c, Baryta-m, Agar, Calc-f, Lach, Phos, Phos-ac, Anac, Plb,etc in elderly peopleLachesis in obese persons--- Capsicum b) Arteriosclerosis-Arnica, Aurum-iod, Baryta-c, Tabac, Plb, Kali-iod, Sumbul, Polyg-avia c) Syphilitic Arteritis-Calc, Kali-iod, Nat-iod, Lach. 12. CEREBRAL HEMORRHAGEBothrops, Bell, Cocculus, Gels, Ipecac, Lach, Opium,Hammelis, Crot-hor,Vipera,Sangui., Hypertension - Nat-M, Glon, Lach, Baryta-Mur, Verat-vir Ruptured Aneurysm--Baryta, Carb-v, Lach, Lyco, Digi, Plb. Capillary---Calc-f, Fl-acid, Tuber 13. CEREBRAL HEMORRHAGE Head Injury: Arnica, Nat-s, Hell, Mille, Allium-c, Hyper,Cicuta Leading to Hematoma-Ars,Apis, Kalmia. Bleeding disorders: Ars, Phos, Crot-h, Nat-sil, Hamm, Lach, Adren Purpura Arn, Sulph-ac, Bovista, Led Leukemia Ars, Nat-ars, Nat-sul, Pic-ac, X-Ray,Benzeneum. 14. CEREBRAL EMBOLISM: Crat, Naja, Lach, Spongia, Stroph, Spig, Kalm, Kali-c, Crot-hor, Calc-f HYPERTENSIVE ENCEPHALOPATHY: Nat-m, Lach, Baryta-m, Glon,Asterias rub. SUB-ARACHNOID HAEMORRHAGEGelsemium DEPRESSED SKULL FRACTURES: Ruta, Ledum, Symphytum 15. SLOW ONSET STROKE SPACE OCCUPYING LESIONS Cerebral tumours:---kali-brom, Zinc-m, Phos, Plb-iod Plb-m, Calc,Conium. Cerebral abscess:--- Arn, Crot-h, Iodum, Lach, Opium,Vipera, Pyrog. Chronic Sub-dural haematoma:---Apis, Ars, Kalmia, Arnica, Calc-f, Nat-s, Sil. INTERNAL CAROTID ARTERY OCCLUSION Hyos, Chen-a, Baryta-m, Syphilinum. 16. REMEDIES ACCORDING TO STAGE OF THE DISEASE Remedies to Prevent the attack; Acon, Amyl, Bell, Apis, Hyos, Opium, Verat-v, Nux-m, Gels, Glon. In chronic cases--Aurum, Calc, Ferrum, Phos, Spongia, Sulph. Remedies During the attack; Acon, Arnica, Bell, Cocculus, Conium, Gels, Hyos, Glon, Lauroc,Lach, Nux-v, Opium. Remedies for Remote changes; Anac, Causticum, Cuprum, Plumbum, Zincum. 17. ANATOMICAL SITE OF LESIONS 18. KALI.BROM,HYOS BARYTA.M,CHEN-AARN,CAUST,HYOSGELSAUR,STRAM, MUR-A,GELS,SEPIA, 19. FEATURES IN DIFFERENT ARTERIAL TERRITORIES AND RELEVANT DRUGS: MAIN BRANCH INTERNA L CAROTIDBRANCH MIDDLE CEREBR AL (MCA)AREAS OF SUPPLYCLINICAL FEATURESMost of the motor & sensory areas, Internalcapsule , speech & auditory areas.Hemi paresis (face& HYOS(deaf arm leg) ness), Hemianesthesia, CHEN-A Dysphasia,dysarthri (aphasia), aHemianopia rarely. BARYTA-M (lt.Hemiple&aphasia)ANTERIO Motor areas R esp. for legs. CEREBR AL (ACA)Hemiparesis (leg arm & face) Incontinence urine & stool.DRUGSARNICA CAUST HYOS 20. POSTERIO Mid brain R Visual area CEREBRAL Thalamus (PCA)VERTEBR- Cerebellum BASILAR Labyrinthine Pons MedullaAmnesia(memory loss) Homonymus Hemianopia Cortical blindness Sensory loss to all modalities,Thalamic pain (spontaneous burning pain)Vertigo, Dizziness, Ataxia, Dysarthria, Diplopia, Nystagmus, Facial weakness / numbness, Bilateral sensory symptoms, Loss of conciousness, Dysphagia, Occipital headache.AURUM STRAMMUR-ACID (numbness+ aphasia) GELS SEPIAPONTINEHemorrhageContra lateral Hemiplegia, Deep coma, Hyper pyrexia, PIN-POINT pupilsOPIUM 21. THERAPEUTICS IN GENERAL 22. ARNICA -H/o- Head injury -Left-sided paralysis -- Involuntary evacuations from bladder and bowels --pulse full,strong, stertorus breathing --Arnica 30,for dissolving blood clots 23. OPIUM -Ruputure of vessels & consequent symptoms of extravasation of blood into the cerebral subatance leading to; -One- sided paralysis, with stertorus breathing , -Jaw dropped -Pin-Point pupils -Tetanic rigidity of the body -Face mottled, purple or hot, hot sweat. -In Drunkards, followed well by Nux-vom -Opium follows Bell in apoplexy. 24. GLONOINE Indicated in the high arterial tension and co-existing kidney disease(Asterias) Monoplegia ( affecting one arm or leg) Stertorus breathing Coma Intense heat Shiny skin & Cold extremities 25. PLUMBUM MET -Apoplexy ,stupor, when Opium is sufficiently similar to remove the cerebral congestion which always surrounds the apoplectic clot, Plumbum may follow. (kent) -Cerebral Tumours and Cerebral Sclerosis -Paralytic weakness of Oneside of the body -Paralysis of muscles (lt.sided)atrophy -Violent pain in the Paralysed parts & Hyperesthesia of normal side. 26. GELSEMIUM In Sub-arachnoid haemorrhage -Nervous affections of Cigar makers -Threatened & actual apoplectic seizure -The symptoms are Stupor General paralysis Headache,nausea Dilated pupils Twitching of the single muscles -Dizziness, drowsiness, dullness & trembling 27. CAUSTICUM Indicated not for congestion, exudation but for the Remote symptoms, when, after absorption of the effused blood has taken place, there still remains paralysis of the opposite side of the body. Right-sided paralysis Paralysis of Single parts Incontinence (Hyos) Contracture of the affected parts. 28. COCCULUS It affects the voluntary muscles rather than the intellectual power. Face red & hot Eyes closed, with the balls constantly rolling Pupils dilated Breathing with out noise Left or Right extremities paralysed; after night watching & exhaustion. CROTOLUS- HOR Cerebral Haemorrhage -- Bleeding disorders Right sided paralysis 29. LAUROCERASUSApoplexy when it occurs suddenly without prodromal; Patient falls suddenly into a comatose state out of which he cannot be aroused; Cold moist skin Convulsion of the muscles of the face. 30. LACHESIS After Liquor, Emotion Left-sided paralysis Cannot bear anything around neck When Conscious talks abruptlyHYOSCYAMUS Falls with a scream Involuntary defecation & urination Inability to swallow Twitching, jerking of all muscles of body 31. ANACARDIUM Loss of Memory In After-effects of Cerebro Vascular Accidents BARYTA-CARB In old people Drunkards Behaves Childish . AURUM-MET Paralysis of tongue, speech imperfect Stammering Mental function unimpaired 32. NUX-VOMICA Paralysis of lower jaw,lower limb Retention of urine Constipation In drunkards, followed by Opium.ZINCUM-MET Senses are affected after attack Fidgety feeling in feet, must move them constantly 33. ACONITE Fromfright Fear,Anxiety,restless Dry&hotskin BELLADONA Redbloatedface Headache>bywarmth DilatedPupil Lossofsight,smell,speech VERATRUMVIRIDE Nausea&Vomiting Quickboundingpulse Thickspeech Redstreakeddownthemiddleoftongue. 34. FEW SNAP SHOTS 35. Hemiplegia with Aphasia-- Bothrops, CenchRt.Hemiplegia with Aphasia -- Bothrops, Cantharis, Chen-a Lt.Hemiplegia with Aphasia -- Baryta-mur Lt. Hemiplegia after hemorrhage Curare Lt.upper limb(monoplegia) Ars.alb For Lacunar Strokes Caust, Curare, Plum-met 36. Aphasia due to Embolism of Middle cerebral artery : Kali-brom Apoplexy followed by idiocy Helleborus Apoplexy in drunkards -- Opium, Nux-vom, Sepia. when coma fails to yield to Opium Apis.mel Apoplexy after excitement --Stannum APOPLEXY: due to Sudden frightAcon, Opium Excessive joy - Coff, Opium Suppression of menses Nux-v, Puls Disappointed love - Phos 37. ALLEN.H.C, Key Notes and Characteristics with Comparisons of some of the Leading Remedies of the Materia Medica with Bowel Nosodes, New Delhi, B.Jain Publishers Pvt. Ltd., 8 th Reprint Edition 1996 BOERICKE, WILLIAM , A Manual of Homoeopathic Materia Medica and Repertory, New Delhi, B.Jain Publishers Pvt. Ltd., Reprint Edition 1996. CLARKE.J.H. A Dictionary of Practical Materia medica, (Vol.I, II, III), New Delhi, B.Jain Publishers Pvt. Ltd., New Issue with additions, Reprint 2000. CLARKE.J.H, A Clinical Repertory to the Dictionary of Materia Medica, New Delhi, B.Jain Publishers Pvt. Ltd., Reprint Edition 2001 COWPERTHWAITE.A.C. A Text Book of Materia Medica and Therapeutics (Characteristic, Analytical and Comparative), New Delhi, B.Jain Publishers, 13th Reprint Edition 2001.FARRINGTON.E.A. Clinical Materia Medica, New Delhi, B.Jain Publishers Pvt. Ltd., Reprint 4 th Edition 2002.KENT.J.T, Lectures on Homoeopathic Ph