1 / 25

BEACON FOUNDATION’S CASE PRESENTATION CONTEST 2006

BEACON FOUNDATION’S CASE PRESENTATION CONTEST 2006. 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 20/8/05.

bronwyn
Download Presentation

BEACON FOUNDATION’S CASE PRESENTATION CONTEST 2006

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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/ Male 20/8/05

  4. 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: 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.

  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. 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 REASONS:

  13. ACUTE PRESCRIBING TOTALITY: • A/F FRIGHT / FEAR • < ANXIETY • HEAD PAIN MORNING 10 a. m. < • STUPEFACTION, AS IF INTOXICATED, HEADACHE DURING, • LAUGHING TENDENCY, IMMODERATELY • PARALYSIS, NUMBNESS WITH, • PARALYSIS, PAINLESS • PARALYSIS ONE SIDED - LEFT

  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: Low Sensitivity: 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. FOLLOW UP ON 14/09/05 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

  25. THANK YOU YOU

More Related