Haematoma
NATIONAL JOURNAL OF HOMOEOPATHY 1996 May / Jun Vol V No 3.
Mishra S C.
Cases.
` Caust.

Editor: This case, a difficult one, shows remarkable improvement with Homoeopathy. Such cases would require frequent changes of medicines, if a clear picture is not immediately perceived. But this case could have done with fewer changes.

Mrs Meena Paul aged 55, very lean, thin and short could hardly finish her work one day, when she fell down with a moaning sound. She was carried to bed in an unconscious state. She was found to be yawning frequently in her unconscious state (as if she wanted to be left alone to sleep as she was completely exhausted). Her right leg and hand were seen paralyzed. The case was diagnosed as CVA (Cerebro Vascular Accident) with right hemiplegia. She was immediately hospitalized after giving a few doses of Aconite 200.

The CT Scan of her brain reported "An area of blood density is seen on left temporo parietal region including basal ganglia and internal capsule, extend higher in parietal periventricular region". Gradually the level of her consciousness began deteriorating. The attending physician at the hospital refused to undertake neuro surgery and pronounced a bad prognosis.

I took her case and gathered the following details: Mental Generals: Very affectionate, meek and mild. Submissive, tolerates everything in silence. Kind, modest, well behaved. Cannot hurt any bodys feeling. Wants to please every body but suffers silently. She being not much educated, is subdued and dominated by her husband, a trade Union Leader. She used to put in lots of hours in running the household and in the process, exhausting herself.

Physical Generals: Lean and thin, short stature, thirst average, stool OK, appetite average. No specific desire for food or drink. No specific aversion or liking. Prefers to be in open air. Hot blooded, sleep good. All her teeth have been extracted earlier due to Pyorrhoea. Past History: Tuberculosis after marriage. Head injury twice by falling down from rickshaw. She used to have recurrent severe headache often beginning in the morning which persisted for a day to two and subsided with some Homoeopathic medicine. She never prefers allopathic medicines as they seem to worsen her general health.

Family History: Nothing could be collected as her parents died in her early childhood.

RUBRICS:

1. kR 88- Timidity
2. KR 86- Sympathetic
3. KR 774- Respiration rattling
4. KR 1176- Hemiplegia Right
5. KR 1256-Yawning
6. KR 1243-Air, Open, desire for.

TREATMENT and FOLLOW-UP:

24/11/93: Caust 200/2 doses half hourly.
25/11/93: Can open her eyes on asking but not always. Tried to sit up. Started moving her eyes but still aphasic. No medicine.
26/11/93: No further improvement.
Caust 1 M /3 doses 1/2 hourly.

In evening she was found to be yawning frequently as before. Level of consciousness was not improving any more. I tried to find out this symptom of yawning during unconsciousness in Kents repertory but failed. In Knerrs repertory I found (Page 1070). Allium-cepa against the rubric "Yawning in deep sleep" I gave her Allium cepa 200/3 doses every 15 minutes. Allium-cepa is also a good medicine for old injury. (H/O head injury long ago).
27/11/93: No change.
Puls 200/1 dose (being her constitutional medicine). At 2:30 pm the patient was found lifting her hand (Left) and placing on head again and again for she was perhaps having headache. She started coughing whenever she was made to drink water with spoon. Her eyes were half open. I consulted Phataks repertory and found Bell under the following rubrics:.
Unconscious (Ph 370) -Bell Throbbing (Ph 168)- bell.
Eyes open half (Ph 117)- Bell.
27/11/93: Noon, Bell 30/4 1 hourly.
28/11/93: She was found irritable salivation ++. Removed Ryles tube on her own but the level of her consciousness was still not improving.
Arnica 200/3, Nat-sulph 200/3 alternately 1 hourly.
29/11/93: Having no other prominent subjective symptoms I decided to try Lachesis being one of the anti coagulant remedy (Bothrops) Lach 1 M/4 doses 1/2 hourly. After Lachesis her comatose sleep became interrupted. She tried to speak. Senses improved but still drowsy +++.
30/11/93: Better, Lach 1 M/4 1/2 hourly followed by Arnica 1M (4 pills in 2 oz of water) 1 TSF TDS.
5/12/93: She started speaking but her talk was irrelevant. She smiled foolishly. Could eat slowly. Drowsy +++, appearance foolish. At this stage she was taken home and again I repertorised with her present symptoms observed after 4 days.

1. KR 71- Recognize does not, his relatives- BELL, Hyos.
2. KR 81- Speech incoherent-HYOS, LACH
3. KR 81- Speech foolish-hyos.
4. KR 82- Speech unintelligible-BELL, HYOS, STRAM.
5. KR 82- Speech intoxicated (Slurred) as if-hyos
6. KR 90- Unconscious conduct automatic-hyos
7. KR 794- Cough inability to-DROS
8. KR 1255-Sleep, waking difficult-Hyos.

5/12/93: Hyos 30 (4 pills in two Oz of water) 1 TSF 4 times a day. The solution was given after the bottle was given 10 jerks vigorously on hand. Physiotherapy was started.

20/12/93: Rt Parietal region feels heavy, speech incoherent. Foolish. Hyos 200 (4 pills) in 2 oz of water shaken well and 10 drops OD morning).

21/1/94: Forgetful, speech slurred. She could not find the exact word to express. Memory weak +++. She stops when speaking to find words for expressing herself but can not succeed inspite of the strenuous effort. After exerting when she fails to get the words, she becomes puzzled, helpless and hopeless and starts breathing hard and gives up further effort to remember.

1. KR 64- Memory weakness, expressing oneself for PLB
2. KR 65- Words for-BAR-C, PLB, Phos-ac
3. KR 88- Thoughts vanishing speaking while- lach., Phos-ac.
4. KR 49- Forgetful words of speaking while-.BOTH, PHOS-AC, Lach.
5. KR 1176-Hemiplegia right-Plb; Phos-ac 200 one dose was given considering the fact that the patient had a deep seated depression for a long time in the past.

1/2/94: No amel.
Plb 200/1 (4 Pills mixed in 2 oz of water and daily 10 drops given after 10 jerks each time OD in 1/2 cup of water).
26/2/94: Very slight amel.
Plb 1 M/1 (in the same way as stated above).
14/3/94: No further amel. Plb 10 M/1 (in water).
27/4/94: Hand feels stiff when stretching out.
Physiotherapy continued. Rhus-t 200/2- doses 6 hourly.
8/5/94: The patient walks slowly without any support of course with spastic gait. CT Scan of her brain taken on 6/5/94 opines "The CT findings suggestive of: An old, almost resolved, left paraventricular Parietal lobe Haematoma without any mass effect".

OBSERVATIONS:

The aim was to restore the consciousness of the patient as early as possible which was considered to be the only sign of improvement in the case. So, I frequently consulted the Repertory and changed medicines accordingly and I found that the patient had been enormously helped with Lach, Hyos and lastly Plumbum to get the Haematoma dissolved. Actually, the patient had been suffering from haematoma for a long time after her head injury by falling down from rickshaw and the episode of her recurring headache indicated it. But the then attending Homoeopath did not try to find the real cause of her headache by taking CT Scan of head. If she had been given proper treatment right from head injury, perhaps she could have been saved from CVA.

Follow up results:

However, the patient survived till 5/12/95. She could walk slowly and helped her daughter-in-law in the kitchen till the day of her death. She had a 2nd attack of cerebral haemorrhage due to high BP in the early morning of 5th December 1995 and breathed her last.

(Dr. Asranis Comments: Intra cerebral bleeding, especially deep-seated and involving internal capsule is not an indication for surgery as it is too deep to approach and in elderly atherosclerotic arteries defy closure. If the bleeding stops spontaneously, resolution of haematoma does occur. What are generally operated are sub-dural haematomas. This patient did not fall and get hurt leading to hematoma. She had a CVA and fell down and hurt herself.).