A Case of Left Sided Oculomotor Nerve Palsy

The oculomotor nerve is responsible for the majority of eye movements (eye, eyelid, and pupil). Paralysis leads to ptosis and pupil dilation. Movement of the eyeball is impaired. Here, the CT SCAN shows left third cranial nerve palsy (due to left posterior communicating artery aneurysm).

Presenting history

1. dropping of left sided upper eye lids (ptosis) since15 days. No pupillary light reflex, mydriasis (pupil dilation), movements of the eye reduced.
2. History of left sided headache for past 5-6 years.

Throbbing pain in temple-left. Angry when disturbed during headache. Scolding others when angry.

During headache pain- sensation as if wants to pull the eye ball out.

1. Vomiting—4-5 days, odor of neem seed.

 

Physical generals

• Chilly patient, can’t tolerate winter or rainy season.
  • Appetite –increased in morning.
  • Thirst—increased only in one week
  •  Motion—4-5 days once, Difficulty to pass stool ++
  • Sleep—sleepy ,overpowering +++
  • Sweat—odor—profuse, offensive—smell of neem seed

Mental generals

One year back the major incident that affected her mind was her son in law’s death. She feels forsaken, nobody is there to take care of her daughter’s family and take care of her health. Her main issue is who will secure her family; who will take charge of her grand children’s education.

While hearing of the son in law’s death she felt shock and fell down suddenly and became unconscious. That time her main experience was shatter and shock.

Great Anxiety about her grand children and family. Fear that someone will speak badly about her grand children.

Fear of an operation and worried that it might end up in death.

Sympathetic in nature

Totality of symptoms

• Forsaken feeling
• Intense anxiety, anticipatory
• Shock and shatter
• Insecurity
• Ailments from grief, shock
• Sleepiness
• Constipation
• Perspiration profuse ,offensive
• Left sided paralysis, left sided headache
• Chilly patient
• Ptosis

 

 

29/9/11

 

Rx:   GELSEMIUM200/1dose

13/10/11

Sleeps well, no sleepiness and drowsiness.

Tiredness is better

Active, energetic.

Stool-no difficulty

Sweat odor—no putrid odor

Appetite—not excessive

Shock completely gone

Shattered felling gone

Drooping eye lid- no change

Pupil dilated no change

Rx   Sl

16/11/11

Generals –all better

Left eyelid can open slightly better. Lachrymation – mild

Able to move the eye lid

Headache – mild – on and off

Rx  Sl

27/12/11

Headache experienced 2 times and was mild

Eyeball movement good

Eye can open better compared to previous stage.

Pupil contracted slightly when light passes.

Rx   sl

11/1/12

No headache

Eyelid opening better

Pupil contraction better

Generals –normal

Rx sl

16/2/12

Eyelid can open 70 %

Pupil contraction—50 %

Generals-good

Rx  Sl

2/4/12

Fever

Vomiting headache, stool-difficulty, body pain

Rx –  GELSEMIUM 200/1d/1pill

5/5/12

Generals –good

Eyelid can close and open fully.

Pupil contraction -80% better

Eyesight –good

No lachrymation

No shock

No shatter feeling

Rx  sl

14/8/12

Generals –good

Eye lid, eye ball movement good

Vision-good

Pupil contraction –still improving compared to previously.

Rx   Sl

Conclusion—

The Gelsemium patient’s reaction is anxiety, like “How could this happen? I was just talking to them yesterday and now they are dead.” Gels feel shock and shatter. Cal carb patient’s reaction is anxious from watching or hearing about cruelty. While watching the cruelty on TV, they leave the room and close their eyes. Fear of operation, opinion of others, Insecurity, Dependent, Horrible sad stories affected her profoundly, Profuse offensive perspiration, Constipation, Chilly patient are the points that favor Calcarea carbonica  It is a right sided remedy, but here the affinity is on the left. Drowsiness is more characteristic of Gels than Calcarea carbonica