PRESENTED BY-

VD. ABHIJEET D. SHEKHAR

(MD SCH.)

WITH MANY THANKS TO RESPECTED

VD. M. SHARMA SIR

HOD AND GUIDE KAYA CHIKITSA DEPT.(M.D. BHU)
 CASE STUDY
NAME- SMT. HAUSABI PATIL
AGE/ SEX- 80/F
ADDRESS- KEKHALE TAL. PANHALA DIST. KOLHAPUR

CHIEF COMPLAINTS- H/O RT. SIDED WEAKNESS SINCE 2

ASSOCIATED COMPLAINS-
HISTORY OF PRESENT ILLNESS-
HISTORY OF PAST ILLNESS-
DAYS
NO COMPLAINTS OF FEVER, CONVULSION
AND COUGH.
PTS. WAS APPRANTLY ALLRIGHT 2 DAYS
BACK. STARDED WITH SUDDEN ONSET OF
RT. SIDED UPPER AND LOWER LIMB
WEEKNESS, CONSULTED WITH GP AND
THEN SHIFTED IN OUR HOPITAL FOR
FURTHER MANAGEMENT.
KNOWN CASE OF
- HYPER-TENSION SINCE 3 YRS ON STAMLO
2.5mg 1OD.
-DM TYPE -2 SINCE 3 YRS NOT ON
REGULAR TREATMENT.
- LT. SIDE LOWER LIMB DVT SINCE 2 YRS
NEVER USE MEDICENE FOR DVT,
PERSONAL HISTORY- TOBACCO CHEWER.
FAMILY HISTORY- NO SIGNIFICANT HISTORY
MANSTRUAL HISTORY- MENOPAUSE SINCE 35 YRS.

ON EXAMINATION-
- BUILT- CACHEXIC AND POORLY NOURISHED
- VITALS- PULSE- 98/MIN , REGULAR
B P- 170/100 MM OF HG
SPO2- 96-98%
TEMP- 98.6 F
RR- 22/ MIN
PALLOR- +, NO CYANOSIS, NO CLUBBIONG.
BILLATERAL LOWER LIMB ODEMA.
NO LYMPHADENOPATHY
PHERIPHERAL PULSES +
CENTRAL PULSES - WELL PALPABLE
DRY AND SCALY LESIONS ON SKIN
HYPERPIGMANTED
• SYSTEMIC EXAMINATION-
– R/S- FEW BASAL CRAPTS ON LT LOWER BASE
– CVS- S1, S2 +, NO MURMERS
– P/A- SOFT, NO HEPATO-SPLENOMAGALY
– CNS- CONCIOUS, ORIENTED, OBEYS V.C., RT. SIDED
WEAKNESS, LT 7TH UMN PALSY, PUPILARY REFLEX,
BILATERAL CATERACT OPERATED
– POWER- RT. U/L- PROX.= 0/5
DISTAL= 0/5
RT. L/L- PROX. = 0/5
DISTAL= 0/5
LT SIDE - NAD
– SENSORY SYSTEM- TOUCH, TEMP, PAIN +
– REFLEXES-
• KNEE JT. ANKLE JT BISEP TRISEP
• RT. --(Absent) --(absent) - -(absent) --(absent)
LT. ++ ++ ++ ++
 INVESTIGATIONS-
• 1- CBC- Hb - 10.3GM%
TLC - 15800
PLAT. COUNT - 3.48 LACS
DIFF. COUNT- N - 78
L - 54
B - 0-1
E - 2
SERUM UREA - 36.5
CREAT - 1.02
ELECTROLYTES - NA-131, K-4.3, CL-91
BLOOD
SUGER - R- 79 MG/DL
HIV, HBsAg -
-VE
• PT/APTT 15/15/1.0 INR - 30 SEC
• CT SCAN - SUBTLE HYPODENCITY WITHIN THE LEFT HALF OF PONS?
ICHMIC IN ETIOLOGY, DEFUSE HYPODENCITY IN PERIVENTRICULAR
REGION AND CENTRASEMIOVAL REGION MOST LIKELY TO BE
ICHIMIC ETIOLOGY.
• CAROTID DOPPLER - ---------
• 2D ECHO - CONSENTRIC HYPERTROPHY OF LT VENTRICLE,
DIASTOLIC DISFUNCTION,
EF- 50%
 LINE OF MANAGEMENT
• 1- NBM
• 2- TPRBP/I-O CHART/ MONITOR/02 BY VENTURI MASK
• 3- IV MANNITOL 20% 100ML 6 HOURLY
• 4- IV EPTION 100 MG 8 HOURLY
• 5- IV PAN 40 1OD
• 6- IV DEXA 4 MG 8 HOURLY
• 7- TAB. STATIX 20 MG HS
• 8- IV FLUIDES 2POINTS
• 9- FOLIES INSERTIONS, RT INSERTIONS
• 10- PHYSIOTHARAPY
 TITLES

• DEFINATION
• STROKE OVER VIEW INCEDENCE AND PREVALANCE OF STROKE
• WARNING SIGNS OF STROKE
• TYPES OF STROKE
• RISK FACTOR AND CAUSES OF STROKE
• SYMPTOMS OF STROKE
• STROKE COMPLICATION
• STROKE DIAGNOSIS
• STROKE TREATMENT
• AFTER STROKE, STROKE REHABILATION, STROKE PROGNOSIS
• STROKE PREVENTION
 DEFINITION

• STROKE IS DEFINED AS FOCAL NEUROLOGICAL

DEFICIT DUE TO A VASCULAR LESION. IT IS
USUALLY OF RAPID ONSET AND BY
DEFINATION LAST LONGER THEN 24 HOURS IF
THE PTS SURVIVE. HEMIPLAGIA IS A COMMON
MANIFISTATION.
 STROKE OVER VIEW INCEDENCE AND
PREVALANCE OF STROKE
• Stroke Overview
• Strokes, or brain attacks, are a major cause of death and permanent
disability. They occur when blood flow to a region of the brain is
obstructed and may result in death of brain tissue.
• Incidence and Prevalence
• Stroke is the third leading cause of death and the leading cause of
disability in the United States. Approximately 600,000 strokes, or
brain attacks, occur in the United States each year and of these,
approximately 150,000 (25%) are fatal.
• Stroke occurs at an equal rate in men and women, but women are
more likely to die. Ischemic stroke occurs more frequently in people
over age 65 and hemorrhagic stroke is more common in younger
people
 WARNING SIGNS OF STROKE
• Strokes, or brain attacks, are medical emergencies that
require immediate medical attention.
• Warning signs of a stroke include the following:
• 1. Sudden numbness or weakness of the face, arm, or
leg, especially on one side of the body
• 2. Sudden confusion, difficulty speaking or
understanding
• 3. Sudden difficulty seeing in one or both eyes
• 4. Sudden difficulty walking, dizziness, loss of balance
or coordination
• 5. Sudden severe headache with no known cause
 TYPES OF STROKES
• Ischemic Stroke
• Approximately 80% of strokes, or brain attacks, are ischemic. They
can develop in major blood vessels on the surface of the brain
(called large-vessel infarcts) or in small blood vessels deep in the
brain (called small-vessel infarcts). Types of ischemic stroke include
embolic infarct, thrombotic infarct, and lacunar infarct. Infarct of
undetermined cause accounts for approximately 30% of cases of
ischemic stroke.
• Tissue death caused by lack of blood (embolic infarct) occurs
suddenly when a blood clot (embolism) forms in one part of the
body, travels through the bloodstream, and lodges in and obstructs
a blood vessel in the brain. Cardiac embolism, in which a blood clot
forms in the heart, accounts for about 20-30% of ischemic strokes.
• Thrombotic infarct (approx. 10-15% of cases) occurs
when a blood clot forms in an artery that supplies the
brain, causing tissue death. This type usually occurs as
a result of plaque build-up in arteries (atherosclerosis )
and develops over time.
• Lacunar infarct (approx. 20% of cases) usually occurs
as a result of arterial blockage caused by high blood
pressure (hypertension). This type of stroke has the
best prognosis.
• A transient ischemic attack (TIA) is a transient event
that is a risk factor for ischemic stroke. In a TIA, arterial
blockage in the brain occurs briefly and resolves on its
own, without causing tissue death. Approximately 10%
of ischemic strokes are preceded by a TIA, and about
40% of patients who experience a TIA will have a
stroke
 • Hemorrhagic Stroke

• Hemorrhagic stroke occurs when a blood vessel in the brain ruptures and bleeds
into surrounding tissue. The bleeding compresses nearby blood vessels and
deprives surrounding tissue of oxygen, causing stroke. Hemorrhagic stroke
usually affects a large area of the brain, is severe, and carries a high risk for
death.

• Intracranial hemorrhages occur when blood vessels located between the brain
and the skull rupture. They can result from traumatic brain injury (TBI) or
develop spontaneously as the result of a blood vessel defect or weakness such as
a bulge in an artery (aneurysm) or arteriovenous malformation (AVM).

• Blood vessel defects can be present at birth (congenital; e.g., berry aneurysm,
arteriovenous malformation) or acquired (e.g., atherosclerotic aneurysm).
Atherosclerotic aneurysm develops when plaque build-up weakens the arterial
wall.

• Intracranial hemorrhage occurs in the space between the brain and the skull, or
cranium. Three membranes-the dura, arachnoid, and pia-surround the brain and
spinal cord.
• Epidural hematoma (i.e., a collection of blood) develops in the
potential space between the outer membrane (dura) and the skull.

• Subdural hematoma develops in the potential space between the

dura and the middle layer membrane (arachnoid). This condition
may become chronic when shrinkage (atrophy) of the brain (often
seen in elderly patients) allows the brain to move more freely within
the skull. High velocity impact to the skull may cause acute subdural
hematoma, which is often fatal.

• Subarachnoid hemorrhage develops in the cerebrospinal fluid-filled

space between the arachnoid and the inner membrane (pia), which
contains major blood vessels. Subarachnoid hemorrhages are usually
caused by a ruptured aneurysm or head injury.

• Intracerebral hemorrhage occurs in blood vessels located in the

cerebrum, brain stem, cerebellum, or spinal cord.
 RISK FACTORS OF STROKE
AND
CAUSES OF STROKE
• The primary risk factor for ischemic stroke is age (over
age 65). High blood pressure (hypertension) and heart
disease are also major risk factors.
• Atrial fibrillation occurs when muscles in the atria
contract too quickly, resulting in an irregular heartbeat
(arrhythmia). Arrhythmia alters blood flow and may
cause blood clots to form in the heart. These clots can
travel through blood vessels to the brain, causing
stroke. Atrial fibrillation causes an almost five-fold
increase in the risk for stroke.
 OTHER RISK FACTORS
• - High cholesterol (hypercholesterolemia)
- Alcohol abuse
• - Infection (e.g., meningitis, endocarditis)
- Brain tumor
• - Narrowing of arteries (arterial stenosis)
Cardiac conditions (e.g., myocardial
infarction
[heart attack], mitral regurgitation) • - Plaque build-up in arteries
(atherosclerosis)
Coagulopathy (blood clotting disorder)
Diabetes • - Secondary hemorrhage following an -
ischemic stroke
Drug abuse (may cause decreased
blood flow and hypertension) • - Sickle cell disease

Family or personal history of stroke • - Smoking

- High blood pressure (hypertension)
• - Sudden rise in blood pressure

• - Surgical incision of an artery (treatment

 SYMPTOMS OF STROKES
• Symptoms of Stroke
• A stroke, or brain attack, is a medical emergency that requires
immediate medical attention. Because most strokes do not
cause severe pain, patients often delay seeking treatment,
resulting in extensive brain tissue damage.
• Symptoms of stroke depend on the type and which area of the
brain is effected. Signs of ischemic stroke usually occur suddenly,
and signs of hemorrhagic stroke usually develop gradually.
Symptoms include the following:
• Difficulty speaking or understanding speech (aphasia)
• Difficulty walking
• Dizziness or lightheadedness (vertigo)
• Numbness, paralysis, or weakness, usually on one
side of the body
• Seizure (relatively rare)
• Severe headache with no known cause
• Sudden confusion
• Sudden decrease in the level of consciousness
• Sudden loss of balance or coordination
• Sudden vision problems (e.g., blurry vision,
blindness in one eye)
• Vomiting
 TIA
• In transient ischemic attacks (TIAs), one or
more symptoms occur suddenly, last a few
minutes, and then subside. These
"ministrokes" also require immediate medical
attention to reduce the risk for damage to
brain tissue and to evaluate the risk for stroke.
 COMPLICATIONS OF STROKE
• Complications that may occur within 72 hours of stroke include the
following:
• Cerebral swelling (edema)
• Increased intracranial pressure (ICP)
• Intracerebral hemorrhage
• Seizures
- Paralysis on one side of the body (hemiparesis) and speech problems
may occur as a result of ischemic cascade. Complications that may develop
gradually as a result of immobility caused by stroke include the following:
• Bedsores
• Blood clots
• Fibrosis of connective tissue resulting in decreased mobility
• Malnutrition
• Pneumonia
• Urinary tract infections (UTIs; if a catheter is required)
 DIAGNOSIS OF STROKE
• Diagnosis of Stroke
• If stroke is suspected, prompt, accurate diagnosis and treatment is
necessary to minimize brain tissue damage. Diagnosis includes a
medical history and a physical examination including neurological
examination to evaluate the level of consciousness, sensation, and
function (visual, motor, language) and determine the cause,
location, and extent of the stroke.
• Physical examination includes assessing the airway, breathing, and
circulation (ABCs) and the vital signs (i.e., pulse, respiration,
temperature). The head (including ears, eyes, nose, and throat) and
extremities are also examined to help determine the cause of the
stroke and rule out other conditions that produce similar symptoms
(e.g., Bell's palsy).
 INVESTIGATIONS
• Blood tests (e.g., complete blood count) and imaging
procedures (e.g., CT scan, ultrasound, MRI) help the
physician determine the type of stroke and rule out other
conditions, such as infection and brain tumor.
• Imaging Procedures to Diagnose Stroke
• When stroke is suspected, computed tomography (CT scan)
is performed as soon as possible. CT scan produces x-ray
images of the brain and is used to determine the location
and extent of hemorrhagic stroke. CT scan usually cannot
produce images showing signs of ischemic stroke until 48
hours after onset, so a repeat scan may be performed.
• Ultrasound uses high-frequency sound waves to produce
images of blood flow through the arteries in the neck that
supply blood to the brain (i.e., carotid arteries) and may be
used to detect blockage. Magnetic resonance imaging (MRI
scan) with magnetic
• resonance angiography (MRA) uses a magnetic field to
produce detailed images of brain tissue and arteries in the
neck and brain, allowing physicians to detect small-vessel
infarct (i.e., stroke in small blood vessels deep in brain
tissue).
• Angiogram involves injecting a contrast agent (dye) into
the bloodstream and taking a series of x-rays of blood
vessels. This test is used to identify the source and location
of arterial blockage and to detect aneurysms and blood
vessel defects.
• An electrocardiogram may be performed to detect reduced
blood flow to the heart (myocardiac ischemia) or irregular
heartbeat (cardiac arrhythmia).
• Single photon emission computed tomography (SPECT)
and positron emission tomography (PET) involve injecting
a radioactive substance into the bloodstream and
monitoring it as it travels through blood vessels in the
brain. These tests allow physicians to detect damaged
regions of the brain resulting from reduced blood flow.
 TREATMENT
GOALS OF THERAPY
1 TOSAVE THE LIFE AND SPEED UP RECOVERY

2 REHABILATION BY PHYSICAL AND

OCCUPATIONAL THERAPIES FOR AGRAINFUL
EMPLOYMENT.

3 TO PREVANT THE RECURRENCE

4 TO REMOVE THE CAUSE IF POSSIBLE

 Treatment for Ischemic Stroke
• Initial treatment for ischemic stroke involves removing the
blockage and restoring blood flow. Tissue plasminogen
activator (t-PA) is a medication that can break up blood clots
and restore blood flow when administered within 3 hours of
the event. This medication carries a risk for increased
intracranial hemorrhage and is not used for hemorrhagic
stroke. Mannitol, a diuretic, may be administered
intravenously (through an IV) to reduce intracranial pressure
during an ischemic stroke.

• Antihypertensives such as labetalol (Normodyne®) and

enalapril (Vasotec®) may be used alone or in combination with
diuretics to treat high blood pressure.

• Antiplatelet agents such as aspirin, clopidogrel bisulfate, and

aspirin with dipyridamole (Aggrenox®) may be prescribed to
reduce the risk for recurrent stroke. Aspirin may also improve
the outcome of a stroke when administered within 48 hours
• Clopidogrel bisulfate (Plavix®) is an antiplatelet medication that is
taken orally, once a day, to help prevent the formation of blood
clots. It is prescribed for patients with atherosclerosis who have
had a recent stroke and is used to prevent recurrence. Patients with
medical conditions that may cause internal bleeding (e.g., stomach
ulcers) should not use clopidogrel.

• Anticonvulsants such as diazepam (Valium®) and lorazepam

(Ativan®) may be prescribed for patients who experience recurrent
seizures after a stroke. .
• Anticoagulants such as warfarin (Coumadin®) may be prescribed to
prevent the formation of blood clots. Patients taking warfarin may
require regular blood tests to monitor coagulation (blood clot
formation) and prevent abnormal bleeding.
 Treatment for Hemorrhagic Stroke
• Hemorrhagic stroke usually requires surgery to relieve intracranial (within
the skull) pressure caused by bleeding. Most of the damage caused by
this type of stroke results from the physical disruption of brain tissue.

• Surgical treatment for hemorrhagic stroke caused by an aneurysm or

defective blood vessel can prevent additional strokes. Surgery may be
performed to seal off the defective blood vessel and redirect blood flow
to other vessels that supply blood to the same region of the brain.

• Endovascular treatment involves inserting a long, thin, flexible tube

(catheter) into a major artery, usually in the thigh, guiding it to the
aneurysm or the defective blood vessel, and inserting tiny platinum coils
(called stents) into the blood vessel through the catheter. Stents support
the blood vessel to prevent further damage and additional strokes.
 After Stroke, Stroke Rehabilitation,
Stroke Prognosis
• After Stroke
• Stroke Rehabilitation
• Recovery and rehabilitation are import aspects of stroke treatment.
In some cases, undamaged areas of the brain may be able to
perform functions that were lost when the stroke occurred.
• Rehabilitation includes physical therapy, speech therapy, and
occupational therapy. Physical therapy involves using exercise and
other physical means (e.g., massage, heat) to help patients regain
the use of their arms and legs and prevent muscle stiffness in
patients with permanent paralysis.
• Speech therapy helps patients regain the ability to speak.
Occupational therapy helps patients regain independent function
and relearn basic skills (e.g., buttoning a shirt, preparing a meal,
bathing).
• Stroke Prognosis
• Prognosis depends on the type of stroke, the degree
and duration of obstruction or hemorrhage, and the
extent of brain tissue death. Most stroke patients
experience some permanent disability that may
interfere with walking, speech, vision, understanding,
reasoning, or memory.
• Approximately 70% of ischemic stroke patients are
able to regain their independence and 10% recover
almost completely. Approximately 25% of patients die
as a result of the stroke. The location of a hemorrhagic
stroke is an important factor in the outcome, and this
type generally has a worse prognosis than ischemic
stroke
 • Stroke Prevention

• Prevention of Stroke

The following measures may help prevent stroke:

• Do not smoke.
• Exercise regularly.
• Limit dietary intake of salt, alcohol, and saturated fat.
• Maintain body weight within an ideal range.
• Use airbags, seatbelts, and child safety seats in automobiles.
• Wear protective helmets when engaging in contact sports, horseback
riding, or riding bicycles.
• People with hypertension or diabetes can reduce their risk for stroke by
controlling their condition through proper medication and appropriate
lifestyle modifications (e.g., regular exercise, weight loss).
• Carotid endarterectomy is a surgical procedure in which atherosclerotic
deposits (plaque) in a carotid artery are removed. This procedure can
reduce the risk for stroke.
 Samprapti of Pakshaghata
• Hatvaykam marutaha paksham dakshinam
vamama aevacha |
Kuryatha chesta nivrutti hi rujam vaka
sthamba aevacha | |
Gruhitva ardha sharirasya sira snayu vishosha
|
Padam sankachyatyekam hastam va
todashulam | |
 Samanya Chikitsa
• Sarpitailam vasamajja abhyanga bastaya |
Snigdaha svedaha nivatamchaha stanam
pravarnani cha | |
Rasa payansi bhojjani swadhu amla lavanani
cha |
Bruhanam yachh that sarvam prshastham vat
roginam| |
 TREATMENT ACCORDING TO
AYURVEDIC PERSPECTIVE
“SNEHANAM SWEDASAYAKUTAM PAKSHAGHATE TU
VIRECHANAM”

CHARAKA SUSRUTHA GENERAL LINE

• Snehanam Sneha Deepan
• Swedana Sweda Pachanam
• Virechana Mrudu shodhana
Sodhana(Pancha karma)
Vasthi Shamana
Shirovasti a]kashtaushadhi
b]rasaushadhi
Rasayana
 SNEHANAM

INTERNAL EXTERNAL
• Ksheerabala taila[v+p]
Karpastyadi tailam[v]
• Madhuyashtyadi tailam[v+p+k]
SWEDANA
Maha masha Tailam
• Shuddhabala tailam [v]
Suddha bala tailam
• Dhanwantaram tailam[v+k]
Dhanwantaram
tailam
• Bala aswangantha tailam[v+p+k]
Kssheerabala Tailam
 SWEDANA

• Nadi swedam -ksira dhoom – in jivha stambha

• Upanaha swedam
• Shastikasali pinda sweda
• Kukutanda sweda [associated pakshaghata with
ardita]
 VIRECHANA
• Two Types
• 1. Kaya - To counter the upward movement of
vitiated pranavata
• 2. Shiro - To repair local damage and improve
local circulation.

• Eranda tailam [v+vk]

• Dhanwantari tailam [v+p]
• Ksheera bala Tailam
• Maha Narayan Tailam
 VASTI&NASYAM
VASTI/SHIROVASTI
• Anuvasanam and niruha vasti
• Siro vasti
• Ksheera bala / dhanwantari [7times]
NASYAM
• Though it is not mentioned in classics, it is an wide
practice for its quick & long lasting results, as it helps
in eradicating the pathology from the brain itself.
• Anu tailam [keval vata]
• Ksheera bala tailam [v+p] (101times)
• Dhanwantari tailam [101 times v+k].
 ESSENTIAL MEDICINES
• AGNI TUNDI VATI AROGYAVARDHINI VATI

• LAXMIVILAS RAS VATA KULANTAK RAS

• SMRITISAGAR RAS KAMDUDHA RASA
• CHANDRAPRABHA VATI SWARNAMAKSHIKA BHASMA
• ASHTAMURTHY RASAYAN CHANDRAKALA RASA
• RASA RAJA RAS YOGENDRA RAS
• VYADHI HARAN RASA EKANGAVEERA RAS
• VATAGAJANKUSHA RAS VATAVIDHWANSINI RAS
• BRIHAT VATA CHINTAMANI GUGGULU KALPAS

• Along with main drugs these drugs play some useful role in the prevention ,
control & recovery of various stages & complications of pakshaghatha.

• DOSE- Dosage of these drugs 65mg-150mg depending upon the

condition.