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Date posted: May 5, 2012

Dr Beenadas

Presenting complaints.
Weakness and heaviness of tongue
Weakness of upper limb – Rt.side , with coldness.
Headache – Rt. Side.      (4 days)

History of presenting complaints.
Complaint started  4 days back as heaviness of tongue  and  right.upper limb in the morning  on waking. There was difficulty in opening mouth.and difficulty in speaking.  There was weakness of right leg and  cannot walk steadily. No loss of consciousness. Now there is burning of both legs.

Had severe headache at night the day before this PC, and bleeding noticed inside mouth. Similar headache had occurred twice with bleeding inside mouth. Headache is > by bleeding and also by tying head tightly with wet towel.

History of previous illness. 

  • R/A of bronchial asthma and UTI
  • R/A of chest pain, that radiates to left shoulder.
  • History of unconsciousness while traveling in bus about 15 years back, admitted at MCH. Then diagnosed hypertension, DM and hypercholesterolemia. Advised sorbitrate. Stopped 3 years back.
  • History of fracture of femur 10 years back. Done surgery. Thereafter some difficulty in walking.

Treatment history.

  • Homoeopathy .
  • Taking allopathic tab daily for hypertension.

Family history
Mother had diabetis mellitus.

Personal history.
Life situation
Place of  birth  – westhill
Educational  status  -  10th std.
Economic status  -  moderate.
Married , has 3  children., habits and hobbies. vegit.
Addicted  to tea..
domestic relations  – good.

Physical features.
Generals
a)    Funtionals :-

  • Appetite normal, likes pungent things.
  • Thirst  – increased, prefers cold water.
  • Sleep  – sleeplessness during night
  • Dreams – dead relatives.

b) Eliminations :-
Bowels  – regular
Urine  – frequency increased at night -4-5 times.
Sweat  _ increased

Response to :- Prefers fanning

Psychic features.
Easily irritated  and worried,  becomes angry.
Weeping  and insecurity feeling, Loneness.

Menstrual history
Hysterectomy at the age of 25.

Regionals.
Head   -  Rt.sided headache. >tight bandage with cold water.
Eyes   -   dim vision – Rt.side
Mouth  – tongue feels heavy, loss of taste
Face- numbness –Rt.side
Chest- pain radiates to shoulder, aching type.
Extremities – difficult walking – rt.leg 

Physical examination.

General

  • Built  – obese
  • Complexion – dark.
  • No wasting, not anaemic, no clubbing, ,no jaundice,  no  lymphadenopathy.
  • No oedema
  • Walding gait
  • R.R – 18/ mit
  • P.R -  72/ mit.
  • BP – 220/110mm of Hg

Systemic examination

  • Respiratory system – b/l rhonchi
  • CVS  -  NAD.
  • GIT  -  NAD.
  • CNS  examination
  • HMF – Normal.

Features of UMN lesion present  (very mild)

Cranial nerves

  • Loss of tactile sensation over the face on right side à Trigeminal nerve, sensory  component
  • Loss of taste – ant. 2/3rd àfacial N, sensory component.
  • Deviation of tongue to right side àhypoglossal nerve.
  • Tongue feels firm  à UMNL

Investigations
Blood RE-
Lipid profile
FBS 

Final diagnosis : CVA- Stroke

Rubrics taken

  • mind-weeping
  • mind-foresaken feeling-isolation sensation of
  • stomach-desires –tea
  • stomach-desires –pungent things
  • stomach-desires –cold food
  • sleep- sleeplessness- at night
  • dreams- dead, of relatives
  • head-pain-cold applications->
  • head-pain –binding >
  • mouth-paralysis-tongue-drawn to-rt
  • extremities –  paralysis- hand-rt.

Medicine 

  • Puls- 19/7
  • Caust-17/7
  • Phos – 16/7
  • Sil- 15/7
  • Arg.n-14/7
  • Nat.mur- 13/7
  • hep- 13/7
  • ars-12/7
  • op-12/5
  • Cal- 11/5

Medicine given.  

  • 8-05-09    Arnica 200-1d
  • 13-05-09   Arnica 1M-1d
  • 20 05=09   kali carb 30 1d

Cerebrovascular diseases
Cerebrovascular diseases include ischemic stroke, hemorrhagic stroke, and cerebrovascular anomalies such as intracranial neurysms and arteriovenous malformations (AVMs).

Definition of stroke by WHO (brain attack)
 “Neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours”.

The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain and its vasculature.If the cessation of flow lasts for more than a few minutes, infarction or death of brain tissue results. When blood flow is quickly restored, brain tissue can recover fully and the patient’s symptoms are only transient: this is called a transient ischemic attack (TIA).

Medicines 

HEAD-cerebral haemorrage

  • 3 – acon, bell,coccu,gel, ip,lache,op
  • 2 – arn, aur, bar.c,camp,china,coff,cro.h, cupr, ferr,hyos, lyco,nat.mur, nux.v, nux.m,   phos, puls
  • 1 – car.veg, con, lauro, mer.sol,nit.ac, plum, sep, stram, tab.

HEAD – Apoplexy

  • 3 – car.v, crot, nux.v,
  • 2 – ip 

ARNICA

  • Arnica is disposed to cerebral congestion, apoplexy, red, full face.
  • Deathly coldness of forearm.
  • Marked effect on the blood.
  • Echymosis and haemorrhages.
  • Tendency to haemorrhage and low-fever states.

RHUS TOX

  • Paralysis of lower extremities, rheumatic origin, or by getting wet.
  • Stiffness in limbs, dragging gait.
  • Pains tearing in tendons, ligaments, and fasciae.
  • The cold fresh air is not tolerated; it makes the skin painful.

CAUSTICUM

  • Paralytic weakness. Paralysis of single nerves or single parts.
  • Ptosis; facial paralysis; paralysis of tongue; of extremities ; of vocal chords ; of bladder ; of rectum
  • Facial paralysis from exposure to dry cold weather.

DULCAMERA

  • Similar to Rhus.tox, simple paralysis of lower extremities, worse from damp ground.

COCCULUS

  • Paralysis of lower extremities from cold. Recent cases with pain in the paralysed part.

BARY.C

  • A paralytic condition runs throughout the pathogenesis. There is paralysis of mind and body. Sensation as if brain loose.
  • Burning pains are found in many parts. General soreness and sensitiveness.
  • Chilliness predominates.

GELSEMIUM

  • The paretic condition is shown in the eyelids, causing ptosis; in the eye
  • muscles, causing diplopia; in the oesophagus, causing loss of swallowing power;
  • Partial paralysis of rectum and sphincter.
  • Partial paralysis of bladder; flow intermittent.
  • Complete relaxation of the whole muscular system.
  • Pain in muscles of back, hips, and lower extremities, mostly deep-seated.

CONIUM

  • The ascending paralysis it produces
  • Difficult gait, trembling, sudden loss of strength while walking,painful stiffness of legs
  • Muscular weakness, especially of lower extremities.
  • Paralysis of ocular muscles.

NUX.VOM

  • Paralysis of lower extremities, contractive sensations and heaviness in the limbs Congestive headache, associated with haemorrhoids.
  • Paresis of ocular muscles; worse, tobacco and stimulants.
  • Paresis of arms, with shocks.
  • Partial paralysis, from overexertion or getting soaked.

ACONITE

  • Paralysis with numbess and paralysis of the parts.
  • Facial paralysis with coldness from exposure to dry cold winds.
  • Acute cases
  • Paraplegia with tingling

PLUMBUM

  • Paralysis with atrophy. Wristdrop, paralysis of extenors
  •  Paralysis due to sclerosis or fatty degeneration.. affect upper extremity more than lower.

PHOSPHORUS

  • Paralysis from fatty degeneration of nerve cells.
  • Progressive spinal paralysis.
  • Paresis of extrinsic muscles.
  • Weakness and trembling, from every exertion.

ALUMINA

  • Paralysis of lower extremity, of spinal origin. Legs feels so heavy that patient drags them.
  • Pain along cord, with paralytic weakness.
  • Arms feel paralyzed.
  • Spinal degenerations and paralysis of lower limbs.

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