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.