BEACON FOUNDATION’S CASE PRESENTATION CONTEST 2006.
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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 20/8/05Location Sensation Modality ConcomitantCNS:
Left upper and
lower limbs
since 10 d
Onset: sudden
gradually
increasing.
-Tingling
numbness
tightness++
-Weakness++,
unable to move
limbs
-Feeling of being
intoxicated+++
-Speech slurred
Immoderate
Laughter
A/F fright, fear
< anxietyHeadache
< morning++
< 9 – 10 am
Location Sensation Modality Concomitant
CVS:2 mths
ago
Lt. UL, LL
Accidentally
detected
Tingling
numbness
Vertigo
Diagnosed as
hypertensive
Put on anti -
hypertensives
Stopped on his
own
A/F fright, fear
>medication
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: RIGHT LEFT
TONE: UL NORMAL
LL NORMAL
MUSCLE POWER
UL NORMAL PROXIMAL 1/5
DISTAL 4/5
LL NORMAL COMPLETE 0/5
REFLEXES
UL NORMAL HYPER ++
LL NORMAL HYPER ++
SENSORY: NORMAL LOSS OF FINE TOUCH
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:
AS THERE IS A DISTINCT
CHANGE IN THE
SUSCEPTIBILITY AS
INDICATED BY THE CHANGE IN
SYMPTOMATOLOGY IN THE
FORM OF CAUSATIVE FACTOR
CHRACTERISTIC
CONCOMITANTS, MODALITIES
AND SENSATION
CONTITUTIONAL:
AS IT WILL HELP HEAL THE
INFARCT AND ALSO DEAL
WITH THE UNDERLYING
CHRONIC DISEASE OF
HYPERTENSION AND
HYPERLIPIDAEMIA WHICH IF
NOT CONTROLLED MAY LEAD
TO FURTHER COMPLICATIONS
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
ACUTE PRESCRIBING TOTALITY:
HOMOEOPATHIC APPROACH TO THE CASE
PRESENCE OF:
• CHARACTERISTIC CAUSATION
• CHARACTERISTIC CONCOMITANTS
• CHARACTERISTIC MODALITIES
• CHARACTERISTIC SENSATION
HENCE BOENNINGHAUSEN’S APPROACH
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
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+++
FOLLOW ON 29/8/05
GAIT IMPROVED FURTHER
• NO TINGLING NUMBNESS.
• BP 120/80
• POWER: SAME
CAUSTICUM 3O IP HS
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
FOLLOW UP ON 14/09/05
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