Transcript Slide 1

BEACON FOUNDATION’S
CASE PRESENTATION CONTEST
2006
A
CASE
OF
CEREBRO- VASCULAR ACCIDENT
PRESENTED
BY
DR. NIRANJAN PAI
M.D. PART –2
DEPARTMENT OF MEDICINE
M.L.D.M.H.I.
PALGHAR
Preliminary Data:
Mr. P. G, 50yrs/ Male
Location
Sensation
CNS:
Left upper and
lower limbs
since 10 d
-Tingling
Modality
A/F fright, fear
< anxiety
20/8/05
Concomitant
Headache
numbness
< morning++
tightness++
< 9 – 10 am
-Weakness++,
Onset: sudden unable to move
 gradually
limbs
increasing.
-Feeling of being
intoxicated+++
-Speech slurred
Immoderate
Laughter
Location
Sensation
Modality
CVS:2 mths
Tingling
A/F fright, fear
ago
numbness
>medication
Lt. UL, LL
Vertigo
Accidentally
Diagnosed as
detected
hypertensive
Concomitant
Put on anti -
hypertensives
Stopped on his
own
No H/O: unconsciousness, convulsion, projectile vomiting, fever, head
injury.
Not K/C/O diabetes mellitus, I.H.D, etc
ON EXAMINATION:
General condition: Fair
P- 84/ min
BP- 150/100 mm hg
RS – clear
CVS – S1 S2 normal
P/A – NAD
CNS –Conscious, co-operative, well oriented in Time, Space and Person
Higher functions / Cranial nerves – normal
MOTOR:
TONE: UL
LL
RIGHT
LEFT
NORMAL

NORMAL

NORMAL
PROXIMAL 1/5
MUSCLE POWER
UL
DISTAL 4/5
LL
NORMAL
COMPLETE 0/5
UL
NORMAL
HYPER ++
LL
NORMAL
HYPER ++
NORMAL
LOSS OF FINE TOUCH
REFLEXES
SENSORY:
IN UPPER and LOWER LIMB
NO PAPILLOEDEMA.
INDICATIONS FOR ADMISSION
• 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
INVESTIGATIONS:
• Hb : 15.2
• 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
E.C.G. : L.V.H. Pattern
CT SCAN – BRAIN
E/o ill-defined hypodense lesion seen in
the Rt high parietal lobe involving
centrum semi ovale, mostly suggestive of
recent non-hemorrhagic infarct in Rt
MCA area.
E/o multiple lacunar infarcts in Rt
internal capsule & basal ganglia.
E/o old small size infarct in Lt anterior
limb of internal capsule in Lt MCA area.
Periventricular white matter ischemic
changes seen.
FINAL DIAGNOSIS:
LT SIDED HEMIPLEGIA, secondary to Rt
MCA non-hemorrhagic infarct involving
Parietal lobe
HYPERTENSION
HYPERLIPIDAEMIA
APPROACH TO THE CASE
CLASSIFICATION : ACUTE COMPLICATION OF
CHRONIC DISEASE
PLAN:
AN ACUTE REMEDY FOLLOWED BY A
CONSTITUTIONAL REMEDY .
REASONS:
ACUTE:
CONTITUTIONAL:
AS THERE IS A DISTINCT
AS IT WILL HELP HEAL THE
CHANGE IN THE
INFARCT AND ALSO DEAL
SUSCEPTIBILITY AS
WITH THE UNDERLYING
INDICATED BY THE CHANGE IN
CHRONIC DISEASE OF
SYMPTOMATOLOGY IN THE
HYPERTENSION AND
FORM OF CAUSATIVE FACTOR
HYPERLIPIDAEMIA WHICH IF
CHRACTERISTIC
NOT CONTROLLED MAY LEAD
CONCOMITANTS, MODALITIES
TO FURTHER COMPLICATIONS
AND SENSATION
ACUTE PRESCRIBING TOTALITY:
1. A/F FRIGHT / FEAR
2. < ANXIETY
3. HEAD PAIN MORNING 10 a. m. <
4. STUPEFACTION, AS IF INTOXICATED, HEADACHE
DURING,
5. LAUGHING TENDENCY, IMMODERATELY
6. PARALYSIS, NUMBNESS WITH,
7. PARALYSIS, PAINLESS
8. PARALYSIS ONE SIDED - LEFT
HOMOEOPATHIC APPROACH TO THE CASE
PRESENCE OF:
• CHARACTERISTIC CAUSATION
• CHARACTERISTIC CONCOMITANTS
• CHARACTERISTIC MODALITIES
• CHARACTERISTIC SENSATION
HENCE BOENNINGHAUSEN’S APPROACH
REMEDIES COMING UP FOR
DISCUSSION
• NUX MOSCHATA
• GELSEMIUM
• OPIUM
• RHUS TOX
• CAUSTICUM
SUSCEPTIBILITY ASSESMENT CRITERIA
•
•
•
•
•
Susceptibility: Low Sensitivity: High
Pace: Slow
Characteristic: Few
Pathology: Structural – Irreversible
Vital organ affected
Posology: low potency, frequent repetition.
MIASMATIC UNDERSTANDING
• 10 a.m. <
• SLOW PROGRESS
• CONFUSION
• INTOXICATED FEELING
• IMMODERATE LAUGHTER
• STIFFNESS
• HYPERLIPDAEMIA
SYCOTIC
FINAL REMEDY:
GELSEMIUM 30 C SINGLE DOSE
gradually in frequent doses
FOLLOW UPS:
21/08/05:
• No headache, no giddiness,
• Mild nuchal pain.
• TINGLING NUMBNESS > 50%
• O/E:
•
BP- 140/90
•
Lt: UPPER LIMB & LOWER LIMB
•
Hypertonia++
•
Power – left shoulder – 4/5 > ++
•
left hip
- 3/5
•
knee & ankle - 0/5
•
GELS 30 QDS
FOLLOW UPS CONTINUED:
23/08/05:
No TINGLING NUMBNESS.
Sensation of tightness in left upper and lower limbs > 75%
POWER: SAME
GELS 200 QDS
26/08/05:
NO SUBJECTIVE COMPLAINTS,
APPETITE, SLEEP NORMAL.
POWER: SAME,
PATIENT CAN WALK WITH SUPPORT REQUIRES LESS
SUPPORT THAN BEFORE
DISCHARGED ON  GELS 1M QDS.
PATIENT AS PERSON
• 5 DAUGHTERS – LOVE ALL OF THEM VERY MUCH.
• 3RD DAUGHTER’S HUSBAND ALCOHOLIC,
ALLEGEDLY KILLED FIRST WIFE.
• PATIENT CONSTANTLY IN TOUCH WITH THE
DAUGHTER ON PHONE. ANXIOUS+++
• 2 MONTHS AGO  UNABLE TO TALK TO HER 
FEAR3 THAT HER HUSBAND KILLED HER ALSO 
BP , TINGLING NUMBNESS IN LEFT SIDE.
• ANXIETY ABOUT DAUGHTER’S AND WIFE’S
FUTURE+++
TOTALITY
•
•
•
•
•
•
ANXIOUS
INDUSTRIOUS
SYMPATHETIC
SENTIMENTAL
AVERSION SWEETS
CHILLY
CAUSTICUM
FOLLOW ON 29/8/05
GAIT IMPROVED FURTHER
• NO TINGLING NUMBNESS.
• BP 120/80
• POWER: SAME
CAUSTICUM 3O IP HS
FOLLOW UP ON 14/09/05
NO INTOXICATED FEELING
NO HEADACHE
NO TINGLING NUMBNESS
POWER: IMPROVED
Lt Hip: 3/5
knee: 1/5
Lt Shoulder: 4/5
CAUSTICUM 30 7P HS
THANK YOU
YOU