HEMIPLEGIA - HOMOEOPATHIC APPROACH

INTRODUCTION-

Hemiplegia is loss of the ability to move and/or feel one side of the body.
Hemiplegia can occur on the entire left or right side of the body. Hemiplegia can also occur
on one specific part of the body (such as the face) on the right or left side. The word
"hemiplegia," comes from the Greek word "hemi," meaning "half," and the word "plege,"
meaning "stroke." Put the two words together and you have "half stroke," referring to half
of the body. A stroke is a burst artery (a type of blood vessel that carries blood away from
the heart) or a blockage of an artery in the brain. Because strokes sometimes lead to loss of
movement and/or sensation in parts of the body, the word "plegia" is used to refer to such
conditions. Strokes and other types of brain damage typically lead to hemiplegia. Other
types of "plegias" include quadriplegia, diplegia and paraplegia.

Although hemiplegia may occur due to various causes, but the most common cause
that leads to hemiplegia is stroke. According to a study of WHO in twelve countries it has
been found that the incidence of stroke rate ranges from 0.2 to 2.5 per 1000 of population
per year. The number is quite significant. If the condition is not well managed it can lead to a
large number of disabilities.

LITERATURE REVIEW

EPIDEMIOLOGY :-
 According to a study of WHO in twelve countries it has been found that the
incidence of stroke rate ranges from 0.2 to 2.5 per 1000 of population per year.

Incidence rates in Western European countries are slightly higher (1.5/1000) but
several European countries and Japan have rates of 3/1000 based partly on environmental
and dietery factors and smoking habits.

Incidence and death rates for stroke are higher among blacks than whites in the
United States.

The condition affects both the sexes in a similar manner. There is a strikingly higher
incidence (20 t0 30 Per 1000) for those over 75 years of age.

In India, analysis of major data from major urban university hospitals suggests that
nearly 2 % of all hospitalized cases are due to strokes. It has also been found that 4.5% of
medical and 20% of neurological admissions are due to strokes.

A random survey showed the prevalence rate for hemiplegia in South India to be
56.9 /1,00,000as compared to 150 to 156 /1,00,000 in US and Europe.

The paralysis presents as weakness which may be present with abnormal tone, such
as rigidity or spasticity. Hemiplegia occurs when there is a disruption of blood flow to the
brain, causing part of the brain to die. The paralysis in the body occurs in the side opposite
the affected part of the brain. For example, if the left side of the brain is injured, then the
paralysis will be on the right side of the body. There are many causes for the presentation
including the following-

Causes of hemiplegia or hemiparesis

  Cerebro-vascular accident (CVA) or Stroke
thrombosis: embolism or hemorrhage
 Transient ischaemic attack (TIA).
 Migraine syndrome.
 Head trauma, brain contusion, Subdural haematoma or epidural hematoma.
 Struge- Weber syndrome.
 Todd"s paralysis.
 Brain tumour (Primary or metastatic disease).
 Infection: brain abscess, encephalitis, subdural empyema or meningitis
 Non-ketoic hyper-osmolar coma.
 Vasculitis.
 Demyelinating disease: Multiple sclerosis, acute necrotising myelitis.
 Hereditary disease: leukodystrophies
 Congenital or perinatal injury
 Arteriovenous malformation.

Symptoms

- Sudden unilateral extremity weakness, loss of function

- Reflects spinal cord or higher involvement

Although there are many conditions and causes leading to hemiplegia but stroke is
adding the maximum bulk to the condition.

The condition can also be differentiated into following groups-

SUDDEN ONSET

!) Vascular-

(a) Haemorrhage.
 (b) Thrombosis.
(c) Embolism.

2) Intracranial infections-

(a) Encephalitis.
(b) Meningitis.

3) Trauma

4) Hypertensive encephalopathy.

5) Post epileptic paralysis.

6) Disseminated sclerosis.

7) Uraemia.

8) Hysteria.

SLOW ONSET-

1) Cerebral tumour.
2) Cerebral abscss.
3) Internal carotid artery occlusion.
4) Chronic sub-dural haematoma.
5) Meningitis, encephalitis.
6) Chorea.
7) G. P. I.
8) Congenital defects.

Determination of hemiplegia in an unconscious patient:-

(i) Conjugate deviation of the eyes away from the paralysed side.
(ii) On hemiplegic side-
 (a) Cheek flaps during respiration.
(b) Nasal fold obliterates.
(c) Corneal reflex diminished.
(d) Pain stimulation less effective.
(e) More flaccidity of limbs.
(f) Paralysed leg extend and assume position of external rotation while
tends to be semiflexed.
(g) Pupil large on side of haemorrhage.
(h) Temperature is higher on paralysed side.

STROKE :

A stroke (also called a cerebrovascular accident) is the death of brain tissue (cerebral
infarction) resulting from lack of blood flow and insufficient oxygen to the brain.

A stroke can be either ischemic or hemorrhagic.

Ischemic stroke :- In an ischemic stroke, the blood supply to part of the brain is cut off
because either atherosclerosis or a blood clot has blocked a blood vessel.

Haemorrhagic stroke :- In a hemorrhagic stroke, a blood vessel bursts, preventing

normal flow and allowing blood to leak into an area of the brain and destroy it.

CAUSES:-
 !. With an ischemic stroke, blockage can occur anywhere along the arterial pathways to the
brain. For example, a large deposit of fatty material (atheroma) can develop in a carotid
artery, reducing its blood flow to a trickle, like water through a clogged pipe. This condition
is serious because each carotid artery normally supplies a large percentage of the brain's
blood supply. Fatty material may also break off from the wall of the carotid artery, travel
with the blood, and become stuck in a smaller artery, blocking it completely. The carotid and
vertebral arteries and their branches can become blocked in other ways. For example, a
blood clot formed in the heart or on one of its valves can break loose (becoming an
embolus), travel up through the arteries to the brain, and lodge there. The result is an
embolic stroke (cerebral embolism). Such strokes are most common in people who have
recently had heart surgery and in people who have defective heart valves or abnormal heart
rhythms (especially atrial fibrillation). A fat embolus is a rare cause of stroke; many emboli
can form if fat from the marrow of a broken bone is released into the bloodstream and
eventually coalesces (consolidates) in an artery.

2. A stroke can occur if inflammation or an infection narrows blood vessels that lead to
the brain.

3. Drugs such as cocaine and amphetamines also can narrow the blood vessels in the brain
and produce stroke.

4. A sudden drop in blood pressure can severely reduce blood flow to the brain, usually
causing the person to faint. However, a stroke can result if the low blood pressure is severe and
prolonged. This situation can occur when someone loses a lot of blood from an injury or during
surgery, has a heart attack, or has an abnormal heart rate or rhythm.

DIAGNOSIS:-
 Stroke can be diagnosed from the history of events and from a physical examination.

The physical examination helps a doctor pinpoint where the brain was damaged.

A computed tomography (CT) or magnetic resonance imaging (MRI) scan is usually

performed to confirm the diagnosis, but these tests may not reveal the stroke until several days
later. A CT or MRI scan also helps rule out whether a hemorrhage or brain tumor caused the
stroke. For the rare occasion when immediate surgery is being considered, the doctor may
perform angiography.

Determination of the precise cause of the stroke is very important. It is of prime importance
to find out whether the stroke was caused by a travelling blood clot (embolism) that reached the
brain or by blockage of a blood vessel from atherosclerosis (atherothrombosis).

When a blood clot or embolism is the cause, another stroke is very likely to follow unless the
underlying problem is corrected. For example, if blood clots are forming in the heart because it's
beating irregularly, treating the irregularity can prevent new clots from forming and causing
another stroke. In this case, the physician generally obtains an electrocardiogram (to look for
abnormal heart rhythms) and may also recommend other tests of the heart. Such tests might
include Holter monitoring, in which an electrocardiogram is taken continuously for 24 hours,
and echocardiography, in which the chambers and valves of the heart are evaluated.

Other laboratory tests are of little help but are performed to be sure that the stroke
wasn't caused by a deficiency of red blood cells (anemia), an excess of red blood cells
(polycythemia), a cancer of the white blood cells (leukemia), or an infection. A spinal tap
(lumbar puncture) is rarely necessary after a stroke. In fact, this test can be performed only
if the physician is sure that the brain isn't under excess pressure, which usually requires a CT
or MRI scan. A spinal tap is performed to check for infection of the brain, to measure the
pressure in the cerebrospinal fluid, or to see if hemorrhage is the cause of the stroke.

DIFFERENTIATION BETWEEN HAEMORRHAGIC, THROMBOTIC & EMBOLIC STROKES

FEATURES HAEMORRHAGIC THROMBOTIC EMBOLIC

Time of onset During activity In sleep

Progression Over minutes or hours On waking up or over Within seconds

hours

TIAs Absent Present

Vomiting Recurrent Absent or occasional Absent or occasional

Headache Prominent Mild or absent Mild or absent

Early resolution (within Unusual Variable Possible

minutes or days)

Meningeal irritation Present Absent Absent

Carotid bruit (and Not seen Highly supportive Possible

absent pulse)

Valvular heart diseases Not seen Unusual Highly supportive

and atrial fibrillation

CT scan Haemorrhage Pale infarct Haemorrhagic infarct

MANAGEMENT:-

Homoeopathic approach-

Conventional medicine conditions us to believe that the symptoms of

cerebrovascular accident (CVA), better known as "stroke" are alike or common in all people.
Paralysis, weakness and defective or absent speech (aphasia ) are examples. Homoeopathy,
however, makes us understand that the symptom picture in any disease is unique to the
individual and must be observed very carefully.

As devastating and frightening as a stroke may be, from a homoeopathic perspective

the symptoms actually represent the attempt of a person's "vital force," or guiding energy,
to correct the imbalance which has resulted in the state. Observing and following the
individual symptom picture will lead the homoeopath to prescribe the remedy most
"similar" to the CVA. The patient should then be on the way to recovery from the energetic
imbalance in a shorter time than if treated by conventional methods only.

Physical Medicine :-

Gentle, regular aerobic exercise can help prevent stroke

A simple hydrotherapy technique may provide relief, and even minimize long term sequelae.

Lowering the body temperature, with a cold bath, as much as possible without
inducing shivering as soon as possible after a stroke has occurred, or is suspected to have
occured. The idea here is that if the stroke is ischemic (temporary restriction of oxygenated
blood) the body naturally and preferentially preserves blood flow to the brain, so cooling the
rest of the body will cause the blood to shunt rapidly to the brain.

If someone has collapsed due to a stroke, and is waiting to get medical attention,
raise the head gently if you are absolutely sure no spinal injury has been sustained, and keep
the paralyzed side up. Don't let the stroke victim lie on the paralyzed limbs if at all possible.
The paralyzed limbs may be massaged to maintain proper circulation

Two of the most distressing sequelae of stroke are inability to speak clearly, and
inability to perform fine motor skills,

For someone struggling to regain the ability to speak normally, speech therapy is
highly recommended.
 To help minimize permanent damage to hand coordination exercises can help a lot
such as the exercise ideas listed below-

- Squeeze a soft or spongy ball with the hands.

- Stretch and reach for objects.
- Counting of coins with the fingers.
- Typing.
- Playing piano.
- Patient can get some help to figure out safe movements routines that will allow him to
bathe himself.

DIET:-

Strokes often occur because of fatty deposits in the arteries, which indirectly
compromises smooth blood flow to the brain, it makes sense to eat a low-fat diet. Strokes
also occur because of insufficient integrity of the walls of the blood vessels, so eating foods
that improve vascular tone, notably the dark-colored berries (whose active ingredient is the
blue-black pigment anthocyanadin) would be wise. In general, the eating principles for
minimizing the chance of a recurring stroke, or to stay as healthy as possible after a stroke,
are to keep the diet:

Low in sugar, low in cholesterol

Low in unsaturated fats
With the calorie percentages of-

70% complex carbohydrates.

 12-15% protein.

15-18% fat (preferably not animal fat).

High in fiber
Low in Sodium. Sodium can raise blood pressure, putting excessive pressure
on the vascular system.

Taking specific juice combinations, at least 5 pints of fresh juice weekly, can work well to
minimize stroke sequelae.

· celery, carrot, prune

· carrot, celery, parsley, and spinach
· carrot and spinach
· carrot, beet, and celery
· carrot, spinach, turnip, and watercress

Other food combinations for post-stroke health to consider, based on taste buds, are:
· Prune and rice polishings.
· Raw goat's milk and 1 tsp. sesame, sunflower, or almond butter, 1 tsp. honey and silver of
avocado.
· Black cherry and egg yolk.

Management of patient of thrombosis or embolism:-

1. POSITION -
 Flat with head low.
 Comatose patients should be turned from side to side every two hours.
 Excessive rotation of the head should be avoided, since this compresses or
streches the vertebral arteries in the neck.
2. MAINTAINANCE OF HYDRATION & NUTRITION-

 In unconscious patients can be achieved by ryle's tube.

 In first 24 hours 5% glucose solution (2000 ml) is adequate.
 This can be replaced after 24 hours when danger of vomiting and active
regurgitation is passed by milk, sugar, eggs, salt and vitamines.
 Food should be given two hours after the change of position

3. CARE OF SKIN:-

 Areas of reddening of skin over heels, ankles, shoulders and elbows are indicative of
pressure necrosis and patient needs frequent position change.

4. TREATMENT OF SHOCK:-

 Maintainance of optimal blood pressure.

 If shock persists then intravenous transfusion.

5. TREATMENT OF HYPERTENSION-

Systolic B.P should be continually lowered at about 100mm of Hg.

6. VASODILATORS-
  In cerebral infarction severe oxygen therapy should be given with 5% Co2 as
oxygen tends to decrease central anoxia and carbon dioxide is best cerebral
vasodilator. Inhalation of the mixture is given 5 to 10 minutes during each hour
for 48 hours after the onset of symptoms and during day time for 4 to 5 more
days.

 Carbon dioxide should not be given if there is any evidence of haemorrhagic

infarction.

7. CARE OF BOWEL & BLADDER

8. PREVENTION OF CONTRACTURE- Paralysed limb should be given full rest of passive

movement.

9. SURGICAL TREATMENT- It is beneficial in cases with vascular insufficiency in progressive

strokes as in complete strokes where the neurological deficit is mild and second episode
may be prevented.

Homoeopathic medicines for stroke-

· Arnica montana for the stroke which gives a cerebral lesion similar to a bruise, or a frank
hematoma (for post acute crisis survival).
· Belladonna is given when the face is flushed and you have a throbbing headache, the pain
which is worse with light, noise, any jarring movement, lying down and in the afternoon,
but better in a semi-erect posture.

· Kali muriaticum can absorb the clot (for post acute crisis survival).

· Natrum muriaticum for when the face is pale and you have a throbbing headache, nausea,
and vomiting.

· Nux vomica is the remedy for when the stroke occurs after a heavy meal or too much
alcohol; and you feel vertigo followed by a momentary loss of consciousness.

· Opium for when the patient is unconscious, breathing heavily; when the face is dusky and
cyanosed (blue, due to lack of blood.).

· Sulphur is for the heavy red-faced beer-drinking type, who complains of feeling heat on
top of his head.

· Veratrum album is given when the clinical picture is one of collapse; shock, sweating and
cold; with a cold sweat on the forehead.

First aid for stroke, if the person loses consciousness:

Aconite 30c: if the person is very fearful

Opium 6c: if the person has collapsed; face is dark and flushed; loud, "snoring"
breathing; cheeks puff out as person exhales

Arnica 6c: Once the person's condition is stable, give every 4 hours for up to 3 days.

AFTER STROKE-
 Aconite and Arnica
Aconite can help alleviate the panic, fright, and shock that accompany a stroke.
Arnica helps to initiate bodywide healing.

Baryta carbonica is helpful for both physical and mental weakness and fatigue following a
stroke

Aurum muriaticum is good if your predominant symptom is depression.

Homoeopathic Medicines for paralysis-

Causticum [Caust]

CHRONIC PARALYSIS from dry, cold weather, especially during the intense cold of
winter, OF SINGLE PARTS OR SINGLE NERVES, as of facial nerve, ptosis; paralysis of tongue
when deglutition and speech are more or less destroyed; palsy of lips; glosso-
pharyngeal palsy, sometimes involving vocal cords; hemiplegia of opposite side of body as
the sequela of apoplexy; gradually appearing palsies; pains in paralyzed parts increase
when lameness decreases; one-sided paralysis, especially of flexor muscles; SENSIBILITY
MOSTLY INTACT; catarrhal and rheumatic conditions; suppressed chronic eruptions;
weeping mood, hopelessness, fear of death.

Nux vomica-
 PARALYSIS LABIO-GLOSSO-PHARYNGEAL; MULTIPLE SCLEROSIS; paralysis from
apoplexy, or cerebral softening, from sexual excesses, abuse of alcohol, after mental
overexertion, combined with sedentary habits; after poisoning by arsenic, after spasms, or
diphtheria; parts cold, numb, emaciated; sick-headache, with dimness of vision, sour
bitter vomiting with over sensitiveness of all the senses; paralysis from exhaustion of the
spinal cord, spinal anaemia, reflex para and hemiplegia, or white softening, or where
paresis of the motor nerve-centres remains after all signs of irritation have passed away;
incomplete paralysis; power of motion not entirely gone, but impeded by painful
twitchings and spasmodic contraction whenever the affected part is exercised; sensation
small of back as if lame; paralysis of arm, with violent jerks in it, as if the blood would
start, out of the veins; staggering walk, when he walks he drags his feet, cannot lift them
up; numbness and deadness of lower legs, coldness of the paralyzed parts; paralysis of the
bladder in old men; great debility of nervous system, with oversensitiveness of all the
senses, in drunken people; worse from motion and slight touch but strong pressure relieves
(China); mercurial tremors.

Phosphorus-

LOCOMOTOR ATAXIA with much burning along spine; great tingling and
formication along spine and in affected extremities; during first stage extreme sexual
excitement. DUCHENNE'S PSEUDO-HYPERTROPHIC PARALYSIS, in repose painless
twitching of the muscles, and when they stopped easily excited again by contact.
PROGRESSIVE SPINAL PARALYSIS, with partial contraction of the affected muscles,
formication and tearing in limbs; anaesthesia with increased heat; periodically returning,
unbearable pains in spine, preventing walking; heaviness and sensation of fatigue,
especially when ascending steps; pains in soles of feet, as if she had walked too much with
sensation as if they were asleep; great irritability and nervousness (Zinc.). PARALYSIS OF
BLADDER, caused or (<) by excessive loss of animal fluids, as semen. HEMIPLEGIA,
facial, aphasic paralysis from thrombosis of left middle cerebral artery or from pressure
upon spinal cord (scoliosis).
Rhus-tox [Rhus-t]

THE GREAT ANTIPARALYTICUM, Myelitis of the anterior horns (infantile

paralysis). Lameness in all extremities and joints, with stiffness, worse on rising after
having been seated for a long time, sensation not much impaired; palsy of one side of the
lower extremities, with dragging, slow, difficult walking; rheumatic palsies from
exposure to wet, strains, or excessive exertions, with painful stiffness, tingling and
numbness; paralysis after ague or typhoid, from sexual excesses, pains in small of back
improved by lying on something hard; hemiplegia, Paraplegia, paralysis of the rectum and
of the bladder, dysphagia paralytica, blepharoplegia, etc.; Bell's paralysis; paresis of one
or more muscles of eyeballs from damp cold; puffiness with paralytic weakness of the
joints, more than oedema, as it does not pit much on pressure., Sulph. follows well.

Aconite.

Hempel, who used Aconite for all ailments claimed that it was the sovereign remedy for
almost every species of paralysis, and its symptoms are certainly indicative of the truth of his
assertion. It has the well-known numbness and tingling. Facial paralysis accompanied with
coldness from exposure to dry, cold winds, especially in acute cases, well indicate the
remedy. Paraplegia with tingling. Rhus, Sulphur and Causticum have paralysis from cold.
Cannabis Indica and Staphisagria have tingling.

Plumbum. [Plum]

Paralysis, with atrophy, is the watchword of Plumbum. Wrist drop, paralysis of the
extensors. Paralysis due to sclerosis or fatty degeneration. Paralysis with contractions. Bayes
states that he has not seen any beneficial results from Plumbum in paralysis of the lower
extremities,and it does seem to affect the upper extremity more than the lower. Ptosis,
heavy tongue, constipation, paralysis after apoplexy, with pale, dry cold skin. Tremor
followed by Paralysis. Paralysis agitans. The mercurial tremor resembles this affection, and
hence Mercurius should be a remedy for paralysis agitans; Plumbum, Atropine sulphate,
Zincum and Hyoscyamus are the principal remedies in this affection. The paralysis of
Plumbum is probably of spinal origin. Cuprum is quite similar to Plumbum in many paralytic
conditions; it seems, however, to have more cramping.

Gelsemium. [Gels]

Complete motor paralysis, rather functional than organic in origin. It is one of our best
remedies in post-diphtheritic and in infantile paralysis. Paralysis of the ocular muscles,
ptosis; the speech is thick from paretic conditions of the tongue. Paralysis from emotions.
Aphonia, paralysis of the larynx. Conium has paralysis of central region; the sensation is little
involved , and the tendency of the paralysis is to move from below upwards. Acute
ascending paralysis. Paralysis of the aged. Argentum nitricum. Post-diphtheritic paralysis;
also paraplegia. Nux vomica. Paralysis of the lower extremities, contractive sensations and
heaviness in the limbs. Paralysis of the bladder in old men.

Rehabilitation:-

Intensive rehabilitation can help many people learn to overcome disability despite the
impairment of some brain tissue. Other parts of the brain can assume tasks previously
performed by the damaged part.

Rehabilitation is started as soon as blood pressure, pulse, and breathing have stabilized.
Doctors, therapists, and nurses combine their expertise to keep the patient's muscles strong,
prevent muscular contractions and pressure sores (which can result from being in one
position too long), and teach the patient to walk and talk again. Patience and perseverance
are crucial.
 After discharge from the hospital, many people benefit from continued rehabilitation in
a hospital or nursing home, in scheduled visits to a rehabilitation center, or at home.
Occupational and physical therapists can suggest ways to make life easier and the home
safer for a person with disabilities.

Prognosis

Many people who suffer a stroke recover all or most normal function and enjoy
years of normal life. Others are physically and mentally devastated and unable to move,
speak, or eat normally. During the first few days, Physicians generally can't predict whether
a patient will improve or worsen. About 50 percent of the patients with one-sided paralysis
and most of those with less severe symptoms recover some function by the time they leave
the hospital and can eventually take care of their basic needs. They can think clearly and
walk adequately, although they may have limited use of the affected arm or leg. Use of an
arm is more often limited than use of a leg.

About 20 percent of the people who have a stroke die in the hospital. The
proportion is higher among the elderly. Certain features of a stroke suggest that the
outcome is likely to be poor. Strokes that cause unconsciousness and those that impair
breathing or heart function are particularly grave. Neurologic losses that remain after 6
months are likely to be permanent, although some people continue to improve slowly. Older
people fare less well than younger people. People who already have other serious medical
problems find it harder to recover.

A prospective study of double blind control trial of cases of hemiplegia

 A prospective study of double blind control trial has been carried out in Dr. A. C.
Homoeopathic Medical College & Hospital, Bhubaneswar and author’s clinic between 1993
till date. A standardized case procedure was adopted and constitutional medicines were
prescribed on the basis of repertorial totality and results were documented which are
presented below-

AIMS & OBJECTIVES-

1) To find out the incidence or prevalence rate of the disease hemiplegia.

2) To find out an average of occurance.
3) To ascertain the most effective drugs and their reliable indications.
4) To determine the most effective potency.
5) To find out the repetition schedule.

METHODOLOGY:-

A prospective study of double blind control trialhave been carried out in Dr. A. C.
Homoeopathic Medical College & Hospital, Bhubaneswarand authors clinic between 1993 till
date. A standardized case procedure was adopted and constitutional medicines were
prescribed on the basis of repertorial totality and results were documented which are
presented below-

CRITERIA FOR THE DIAGNOSIS OF THE CASES :-

(1) Paralysis either left or right side of the body that can be diagnosed from the history
of events and from physical examination.
(2) On examination, patient may show hypertension.