Reversal of Pathology in Cerebrovascular Accident

ABSTRACT

This is a case of a 67- year old male with aphasia following cerebrovascular accident (infarct) of middle cerebral artery. The homeopathic medicine Nux Vomica was given in infrequent doses along with auxiliary mode of management after proper analysis/evaluation and repertorization. There was marked improvement in aphasia and changes were seen in the vascularity of the brain.

CASE REPORT –

A 67- year old male, came to OPD, with a history of stroke 2 years ago and he was brought to the OPD on 22^nd May 2015. He is a retired Marine Engineer who had MRI of a stroke of 10^th August 2014. Due to the stroke the right side of his body was affected, especially extremities and jaw and currently he complained of difficulty in pronunciation of words, difficulty in comprehension, difficulty in recognition of words and letters and difficulty pronouncing names. He also made mistakes in writing and spelling. He was not well oriented with time.

He came to us with quite slow improvement with speech therapy which he was taking from The Ali Yavar Jung National Institute For Hearing And Handicapped, Mumbai, India. He also complained of pain in the lumbosacral region which was aggravated by rising from a sitting position.

He was addicted to alcohol and cigarettes which he has stopped 10 months prior. He gets angry very easily about very small matters. He wants his things to be kept in a very orderly manner.

He is workaholic and will not eat until he finishes his work. He was married at age of 40 as he had Ischemic Heart Disease and he thought that his risk of survival was less than normal adults. He got divorced 18 years ago.

History from relatives: His son said that the patient used to stay alone, is very fastidious and meticulous and hence the son and wife couldn’t adjust with this situation. Memory weak for what he has done. He had profuse perspiration. Thirst for sips of water at short intervals. Thermally he was chilly. He has a habit of grinding of teeth while thinking.

F/H/O – Father – hypoglycaemia, Grandfather – Asthma, Mother – IHD

P/H/O – Myocardial Infarction – Inferior wall – 27/12/1973. Chickungunya – Oct 2012, Warthin’s tumour on right face near jaw – operated, Stroke on 10/08/2014.

INVESTIGATIONS.

13/8/2014- 2D Echo Doppler Study. Mild hypokinesia of basal inferior wall. LVEF is 50%. Evidence of concentric LVH. Aortic valve is mildly sclerosed with adequate opening. Type 1 diastolic dysfunction.

10/08/14 – MRI Brain Angiography.

Fairly large areas involving infarct in left parieto-occipital territory with early laminar cortical necrosis/ petechial haemorrhages – moderate brain parenchymal atrophy with B/L ischemic changes. Also, there is diffuse narrowing of M1 segment of left MLA with attenuation of its perisylvian branches. Right posterior communicating artery is hypoplastic.

08/11/2016 – MRI brain.

Shows changes of temporal evolution of infarct. The right posterior communicating artery which was hypoplastic, now appears normal. The narrowing of left MCA shows improvement.

ANALYSIS –

After complete case taking, the following rubrics were taken,

MIND – Fastidious

MIND – Anger on trifles

MIND – Mistakes, calculating in

MIND – Mistakes, time in

MIND – Mistakes, writing in

MIND – Memory weak, recent facts

PERSPIRATION – profuse

Rx:  On the basis of these symptoms Nux Vomica 200 was given on May 27, 2015.

REPERTORIZATION

FOLLOW UP   Patient was on Nux Vomica for 18 months and doing well. We started with 200 potency and increased it to 1M, and 10M as the action of potency was exhausted.

DATE	FOLLOW UP	TREATMENT
03.06.2015	Weakness of memory-SQ (Status Quo) Orientation of time-SQ, Difficulty in speech– SQ, Pronunciation of words– SQ, Ability to comprehend –SQ, Gen – Normal.	SL 200 TDS x 15 days.
19.06.2015	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– SQ, Pronunciation of words– SQ, Ability to comprehend –SQ, Gen – Normal	NUX VOM 200(3P) x 15 days.
17.07.2015	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– >- Pronunciation of words– >- Ability to comprehend –SQ, Gen – Normal	NUX VOM 200 (3P) x 15 days
31.07.2015	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– >- Pronunciation of words– >- Ability to comprehend –SQ, Gen – Normal	SL 200 (1P) x 15 days.
14.08.2015	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– >- Pronunciation of words– >- Ability to comprehend –SQ, Writing difficulty-SQ, Gen – Normal	NUX VOM 200 (1P) x 15 days
28.08.2015	Weakness of memory->- Orientation of time->- Difficulty in speech– >- Pronunciation of words– >- Can speak few words now. Ability to comprehend –SQ, Gen – Normal	NUX VOM 200 (1P) x 15 days
12.09.2015	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– >- Hesitation is better. Pronunciation of words– >- Speech improved. Ability to comprehend –SQ, Gen – Normal N/C – Eruptions on lateral aspect of fingers and toes.	NUX VOM 200 (1P) x 15 days. This prescription was repeated for every 15 days till 20.2.2016
20.02.2016	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– SQ Pronunciation of words– SQ- Ability to comprehend –SQ, Gen – Normal.	NUX VOM 1M (1P) x 15 days
12.03.2016	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– >- Pronunciation of words– >- Ability to comprehend –SQ, Gen – Normal N/C – Eruptions on lateral aspect of fingers and toes	NUX VOM 1M (3P) This prescription was repeated for every 15 days till 12.03.2016
07.05.2016	Weakness of memory-SQ, Orientation of time-SQ, Difficulty in speech– >- Hesitation ->>- Pronunciation of words– >>- Can speak few sentences now. Ability to comprehend –SQ, Gen – Normal	NUX VOM 10M (1P).This prescription was repeated for every 15 days till 17.11.2016
18.11.2016	Weakness of memory->- Orientation of time->>- Difficulty in speech– >- Hesitation ->>- Pronunciation of words– >>- Can speak  sentences now. Ability to comprehend –>>- Gen – Normal. MRI dated 08.11.2016 showed evolution of infarct. The narrowing of left MCA also showed improvement. (Refer attachment 2b)	NUV VOM 10M (1P)
27.01.2017	Weakness of memory->>70%- Orientation of time->>-80% Difficulty in speech– >-75% Pronunciation of words– >-80% Ability to comprehend –>>- 80% Gen – Normal Patient resumed his work. He is now able to comprehend the complexities involved at workplace and give his best suggestions.	NUX VOM 50M (3P)

AUXILIARY MEASURES

Patient was asked to continue with speech therapy.

DISCUSSION

Various homoeopathic remedies are known to treat speech disturbances ( KENT REPERTORY – ) but no scholastic articles were found regarding scientific trials of managing aphasia quotients. Many individual articles are found but no standardized management is found.

In this patient, the improvement was seen even after 1 year from suffering stroke. The patient was engaged in speech therapy which had shown partial improvement after 1 year of therapy. On introduction of homeopathy the speed of recovery increased exponentially.

Along with his other physical generals, his mood and congeniality also improved along with relationship with his family members which had not been good.  He started going back to the factory to give consultation advice in production of instruments required for marine engineering. He’s able to comprehend the complexities involved in manufacturing and able to advise his friends as he did before. Occasionally, he finds difficulty in recollecting technical jargon.

A repeat MRI showed a good amount of resolution of the area of infarct and improvement in hypoplasia  of right posterior communicating artery and changes in the blood vessels supplying cerebral cortex, namely MCA and its anastomosis.

REPETETION OF DOSE – ^[8]

Reference – Organon of Medicine, 6^th edition, aphorism 278. In order to bring about a gentle remedial effect, the dose must be small, and it should act on the diseased part of the organism, unlike allopathy which acts on those parts which are unaffected by the disease. Here too, we found it difficult to regulate/decide the dose a priori, hence began with 200 potency with waiting period by giving placebo and then increasing the repetition, followed by increasing the potency.

WHAT DID WE LEARN FROM THIS CASE?

Dr. Hahneman in his 6^th edition of Organon of Medicine, in the introductory part says, “Cessat Effectus Cessat Causa”, which means: remove the effects and the cause will disappear. This is exactly what we observe in this case, as and when the symptoms improved, the cause that is the pathology also improved which is evident in the MRI.