1. BEACON FOUNDATION’S CASE PRESENTATION CONTEST 2006

2. 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

3. Preliminary Data: Mr. P. G, 50yrs/ Male20/8/05 LocationSensationModality Concomitan t CNS: 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 < anxiety Headache < morning++ < 9 – 10 am

4. LocationSensationModalityConcomitant 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

5. ON EXAMINATION : General condition: Fair P- 84/ min BP- 150/100 mm hg RS – clear CVS – S1 S2 normal P/A – NAD

6. CNS –Conscious, co-operative, well oriented in Time, Space and Person Higher functions / Cranial nerves – normal MOTOR:RIGHTLEFT TONE: ULNORMAL  LLNORMAL  MUSCLE POWER ULNORMALPROXIMAL 1/5 DISTAL 4/5 LL NORMALCOMPLETE 0/5 REFLEXES UL NORMALHYPER ++ LL NORMALHYPER ++ SENSORY:NORMALLOSS OF FINE TOUCH IN UPPER and LOWER LIMB NO PAPILLOEDEMA.

7. 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

8. 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

9. 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.

10. FINAL DIAGNOSIS: LT SIDED HEMIPLEGIA, secondary to Rt MCA non-hemorrhagic infarct involving Parietal lobe HYPERTENSION HYPERLIPIDAEMIA

11. APPROACH TO THE CASE CLASSIFICATION : ACUTE COMPLICATION OF CHRONIC DISEASE PLAN: AN ACUTE REMEDY FOLLOWED BY A CONSTITUTIONAL REMEDY.

12. 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

13. 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:

14. HOMOEOPATHIC APPROACH TO THE CASE PRESENCE OF: CHARACTERISTIC CAUSATION CHARACTERISTIC CONCOMITANTS CHARACTERISTIC MODALITIES CHARACTERISTIC SENSATION HENCE BOENNINGHAUSEN’S APPROACH

15. REMEDIES COMING UP FOR DISCUSSION NUX MOSCHATA GELSEMIUM OPIUM RHUS TOX CAUSTICUM

16. SUSCEPTIBILITY ASSESMENT CRITERIA Susceptibility: LowSensitivity: High Pace: Slow Characteristic: Few Pathology: Structural – Irreversible Vital organ affected Posology: low potency, frequent repetition.

17. MIASMATIC UNDERSTANDING 10 a.m. < SLOW PROGRESS CONFUSION INTOXICATED FEELING IMMODERATE LAUGHTER STIFFNESS HYPERLIPDAEMIA SYCOTIC

18. FINAL REMEDY: GELSEMIUM 30 C SINGLE DOSE gradually in frequent doses

19. 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

20. 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.

21. 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+++

22. TOTALITY ANXIOUS INDUSTRIOUS SYMPATHETIC SENTIMENTAL AVERSION SWEETS CHILLY CAUSTICUM

23. FOLLOW ON 29/8/05 GAIT IMPROVED FURTHER NO TINGLING NUMBNESS. BP 120/80 POWER: SAME CAUSTICUM 3O IP HS

24. 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

25. THANK YOU YOU