CEREBROVASCULAR ACCIDENTS <Brain Attack>- HOMOEOPATHIC ANALYTICAL APPROACH Dr.K.Ram Kumar M.D(Hom) Senior Medical Officer Directorate of AYUSH Govt of NCT of Delhi.
CEREBROVASCULAR ACCIDENTS <Brain Attack>-
HOMOEOPATHIC ANALYTICAL APPROACH
Dr.K.Ram Kumar M.D(Hom) Senior Medical OfficerDirectorate of AYUSHGovt of NCT of Delhi.
CEREBROVASCULAR ACCIDENTS
STROKE(APOPLEXY)
The rapid onset of focal neurological deficit,
resulting from diseases of the Cerebral vasculature and its contents.
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.
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.
RISK FACTORS
MAJOR RISKSArterial HypertensionDiabetes mellitusSmoking Hyperlipidaemia Polycythaemia, sickle
cell anemiaThrombocythaemia Heart failure, Atrial
fibrillation,Infective endocarditis
MINOR RISKSHigh alcohol intakePositive family historyOral ContraceptivesTrauma
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.
HOMOEOPATHICTHERAPEUTICAL
APPROACH
THE GOALS OF THERAPY
TO AVOID DEVELOPMENTOF CEREBRAL INFARCTION
AND IF, PRESENT ALREADY
TO PREVENT ITS PROGRSSION OR RECCURENCE
THERAPEUTICS
Based on;
Mode of onset of the disease & Aetiology
Anatomical Site Of lesions
Stage of the disease
COMMONLY INDICATED REMEDIES
ACONITEARNICAAGARICUSALUMINAAURUMBARYTA-CBARYTA-MBELLADONABOTHROPSCALC-C CALC-FCAUSTICUMCOCCULUS
CROT-HORCROT-CASCGELSEMIUMGLONOINEIPECACLACHESISNUX-VOMNUX-MOSOPIUMPHOSPHORUSPLUMBUMVERAT-VIRZINCUM
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 people—Lachesisin 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.
CEREBRAL HEMORRHAGE
Bothrops, 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
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.
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 HAEMORRHAGE-
Gelsemium
DEPRESSED SKULL FRACTURES: Ruta, Ledum, Symphytum
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.
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.
ANATOMICAL SITE OF LESIONS
KALI.BROM,HYOSBARYTA.M,CHEN-A
ARN,CAUST,HYOS
AUR,STRAM,
MUR-A,GELS,SEPIA,
GELS
MAIN BRANCH
BRANCH
AREAS OF SUPPLY
CLINICAL FEATURES
DRUGS
INTERNAL CAROTID
MIDDLE CEREBRAL (MCA)
Most of the motor & sensory areas, Internalcapsule, speech & auditory areas.
Hemi paresis (face& arm leg) Hemianesthesia,Dysphasia,dysarthriaHemianopia rarely.
HYOS(deafness),
CHEN-A(aphasia),BARYTA-M(lt.Hemiple- &aphasia)
ANTERIORCEREBRAL(ACA)
Motor areas esp. for legs.
Hemiparesis (leg arm & face)Incontinence urine & stool.
ARNICA
CAUST
HYOS
FEATURES IN DIFFERENT ARTERIAL TERRITORIES AND RELEVANT DRUGS:
VERTEBR- BASILAR
Cerebellum LabyrinthinePonsMedulla
Vertigo, Dizziness, Ataxia, Dysarthria, Diplopia, Nystagmus, Facial weakness / numbness, Bilateral sensory symptoms, Loss of conciousness, Dysphagia, Occipital headache.
MUR-ACID(numbness+aphasia)
GELS
SEPIAPONTINE
HemorrhageContra lateral Hemiplegia, Deep coma, Hyper pyrexia,PIN-POINT pupils
OPIUM
POSTERIOR CEREBRAL
(PCA)
Mid brain
Visual area
Thalamus
Amnesia(memory loss)
Homonymus Hemianopia
Cortical blindness
Sensory loss to all modalities,Thalamic pain (spontaneous burning pain)
AURUM
STRAM
THERAPEUTICS IN
GENERAL
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
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.
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
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.
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
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.
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 noiseLeft or Right extremities paralysed;
after night watching & exhaustion.
CROTOLUS- HOR Cerebral Haemorrhage
-- Bleeding disorders Right –sided paralysis
LAUROCERASUS
Apoplexy 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.
LACHESIS
• After Liquor, Emotion• Left-sided paralysis• Cannot bear anything around neck• When Conscious talks abruptly
HYOSCYAMUS
• Falls with a scream• Involuntary defecation & urination• Inability to swallow• Twitching, jerking of all muscles of body
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
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
ACONITE• From fright • Fear, Anxiety, restless• Dry & hot skin
BELLADONA• Red bloated face• Headache > by warmth• Dilated Pupil• Loss of sight , smell, speech
VERATRUM VIRIDE• Nausea & Vomiting• Quick bounding pulse• Thick speech• Red streaked down the middle of tongue.
FEW SNAP SHOTS
Hemiplegia with Aphasia -- Bothrops, Cench
Rt.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
Aphasia due to Embolism of Middle cerebral artery : Kali-brom
Apoplexy followed by idiocy – HelleborusApoplexy in drunkards -- Opium, Nux-vom, Sepia.when coma fails to yield to Opium – Apis.melApoplexy after excitement --Stannum
APOPLEXY: due to Sudden fright – Acon, Opium Excessive joy - Coff, Opium Suppression of menses – Nux-v, Puls Disappointed love - Phos
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., 8th 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 4th Edition 2002.
KENT.J.T, Lectures on Homoeopathic Philosophy, New Delhi, B.Jain Publishers Pvt. Ltd., Reprint Edition 1997.
KENT.J.T, Repertory of Homoeopathic Materia Medica, New Delhi, B.Jain Publishers Pvt. Ltd., 6th Edition.
KENT.J.T, Lectures on Homoeopathic Materia Medica, B.Jain Publishers Pvt. Ltd., Reprint Edition LILIENTHAL, SAMUEL, Homoeopathic Therapeutics, Calcutta, Sett Dey & Co., Reprinted Edition 1969. OXFORD, Text Book of Medicine,davidsons and harrisons etc MURPHY ROBIN’s, Homoeopathic Medical Repertory, New Delhi, Published by Indian Books and
Periodical Syndicate, 1st Indian Edition, 1994. Other relevant Websites and homoeoathic softwares.etc…
The effort made in this work is not merely to arrive at any conclusion regarding the scope of homoeopathic doctrine over cerebro vascular diseases alone. It is also to infuse interest into the future researches in homoeopathy confined to various remedies belonging to the materia medica to show a delicate focus in the study of individual clinical conditions. in doing such works in future a better understanding of the armamentarium of homoeopathic materia medica will be obtained.these efforts correspondingly will ensure
A better understanding of the hidden symptoms in our vast materia medica could be explored.
. A better approach in several clinical conditions by which, the therapeutic value of Homoeopathic materia medica gets enriched.