Haematoma / possible cavernoma with Ayurvedic treatment Management of Frontal Haematoma / possible cavernoma with Ayurvedic treatment Dr.A.Manoj Kumar Senior Medical Officer Govt. Ayurveda Dispensary, Pulamanthole Malappuram-District, Kerala-State, India. E mail : drmanojareekkat@gmail.com Ph : +91 94472 42673

Case Summary The patient was admitted in Modern medicine hospital with the history of recurrent episodes of loss of consciousness followed by tonic clonic movements of the limbs for the last several years. Last episode was one week before. No history of Headache, vomiting, weakness of limbs. He is a known Diabetic on Allopathic medication and no history of Hyper tension. MRI Brain was taken on 02.12.2004 and was diagnosed with Frontal Haematoma / Possible cavernoma and neuro surgeons advised surgical intervention. As there was a possibility of tumour bleed, the doctors refused to do surgery. Patient then preffered Ayurveda Treatment and was evaluated thouroughly by Ayurvedic parameters like pulse examination, assessment of constitution and the imbalance of Doshas. He was found to suffer from Sever Headache, weakness of the body, loss of balance, seizure disorders with type II DM at the beginning of Ayurveda treatment.

Description of Patient Name of Patient - Mr.P.B Age - 52 yrs Gender - Male Nationality - Indian State - Kerala District - Malapuram Appearance - Moderately built Physical and mental disposition – Average Occupation - Construction Worker Socio-economic status – Middle class.

Complaints # Severe head ache as if head is compressed with a clamp with tightened screws. # Feels difficulty to control the body while walking. # Fear of falling down while standing and walking. # Sometimes convulsions of the limbs happens without knowing. # Last episode of seizure disorder was one week before.

Baseline Findings Patient gives history of recurrent episodes of loss of consciousness followed by tonic clonic movements of the limbs for the last several years. Last episode was one week before. Severe headache and weakness of limbs and loss of balance of body while walking. He fears falling down because he feels that the strength of the body is gradually loosing. He is a known Diabetic and on allopathic medication. O/E He was conscious and oriented. Investigation 02/12/04 MRI Brain:Left Frontal hyperintense lesion suggestive of Haematoma. ECG:Normal, Blood:Hb 11.8g%, ESR:48mm/1st Hr, T.RBC:3.9M/cumm, PCV:36%, T.WBC:5900cumm, DC:N62%, E:5%, L33%, Platelets:3.6L/cumm, RBS:191mg%, B.Urea:26mg %, S.Creatinine:0.7mg%

Investigation MRI of Brain on 02.12.2004 shows Left Frontal white matter shows a round (1.8Cm) mixed intencity lesion with a thin and complete peripheral hypodensrim. The Lesion apper hyperdense and Hetterogenous in T1W1suggestiveof Haematoma; probably benign. Adviced followup contrast enhansed MRI to rule out a possibility of a tumour bleed. MRI of Brain (follow up study) on 28.01.2005 shows Hyper intense lesion in the left fronto parietal white matter on T1 and T2 weighted images. Comparing with old images taken on 02.12.2004 the lesion shows reduction in size. Possibility : CAVERNOMA MRI of Brain (follow up study) on 30.03.2005 shows Morphology is suggestive of No focal Neuroparenchymal lesion seen.

Histories Past history of childhood epilepsy : +ve Family History : Negative No history of hypertension.

Diagnosis Frontal Haematoma / possible cavernoma. It was pre diagnosed biomedically by a neurologist. From the Ayurvedic point of view the condition was diagnosed as Granthi (Cyst) associated with Sopha(swelling)in the brain with involvement of Raktha(Blood).

Treatment Plan 14/12/2004 : Internal medication Varanadi kashayam 60ml(freshly prepared) twice daily one hour before food. Gulguluthikthakam kashayam 60ml(freshly prepared) twice daily one hour after food. 3. Dasamoolahareethaki Lehyam 10gm HS. After 45 days Brahma Rasayana started. Internal medication continued for three and half months. External- Abhyanga(oil massage) with Dhanwantharam thailam was done for 21 days. Due to involvement of Raktha(Blood) and Sopha(swelling), Dashamoola harithaki Lehyam and Gulguluthikthakam kashayam were used.Varanadi Kashayam was used as it is indicated in Antharvidhradhi(Internal abscess and granthi). Brahmarasayana was indicated for the purpose of rejuvenation. Dhanwantharam thailam was used for its general effect in pacifying Vatha and improving motor functions.

Midpoint and Progress Follow up study MRI of Brain was done on After 6 weeks of treatment, patient showed remarkable improvement. Severity of headache reduced, balance and strength of the body regained partially. Number of episodes of loss of consciousness followed by tonic clonic movements of the limbs also reduced significantly. Follow up study MRI of Brain was done on 28/01/2005, which shows comparing with old MRI images taken on 01/12/2004, the lesion shows reduction in size.

Progress of the treatment Patient well responded to the treatment. Patient shows remarkable improvements. His complaints such as head ache and loss of balance and strength of the body and seizure disorders subsided significantly.

Endpoint findings Within three and half months of treatment the patient showed remarkable improvement. Severe head ache relieved and balance and strength of the body regained almost completely. Frequency and intensity of seizure disorders remarkably reduced. There is no single episode have been recorded ever since the treatment. Follow up study MRI of Brain was done on 30/03/2005 which shows : Morphology is suggestive of no focal neuroparanchymal lesion seen.

BT AT Comparison Before Treatment After Treatment Severe headache, loss of balance and strength of the body Headache reduced significantly, Balance and strength of the body regained almost completely. Frequency and intensity of tonic clonic movements of the limbs are more severe. Frequency and intensity of tonic clonic movements of the limbs are reduced significantly MRI of Brain taken 02/12/2004 prior to treatment shows a round 1.8cm mixed intensity lesion with a thin and complete peripheral hypodense rim. MRI of brain taken after the treatment on 30/03/2005 shows no focal neuro parenchymal lesion seen.

Conclusions Treatment given to the patient showed positive impact on each stage and observed subjective and objective parameters which were highly result oriented. Patient also showed remarkable improvement and almost relieved from the complaints. I am sure that the positive effect showed by the patient was surely by my treatment and I have observed almost the same effect on some other cases. Patient didn’t undergo any other treatment except anti diabetic allopathic medicine during my treatment period.