🔺CASE STUDY : NO 44 🔺 PART NO : 1 🔺 (EKANGAVATA HEMIPLEGIA ) 🔺 NIDANA (ETIOLOGY / CAUSATIVE FACTORS) -Vata-dushtikara nidana (causes aggravating Vata) are the primary causes: -Ati vyayama (excessive exercise) -Ruksha ahara (dry and light food) -Shoka (grief), Bhaya (fear) -Vega dharana (suppression of natural urges) -Excessive sexual activity -Old age -Exposure to cold and wind -Trauma (Abhighata) (Reference: Charaka Samhita, Chikitsa Sthana 28/6-7 Ashtanga Hridaya, Nidana Sthana 15) 🔺PURVARUPA (PRODROMAL SYMPTOMS) -Early signs before full manifestation of Ekangavata: -Toda (pricking pain) in limbs -Sankocha (stiffness) -Spandana (fasciculations or twitching) -Bhrama (giddiness) -Daurbalya (weakness in limbs) (Reference: Charaka Samhita, Chikitsa Sthana 28/37-38) 🔺LAKSHANA (CLINICAL FEATURES / SYMPTOMS) -Loss or reduced movement in one part of the body (usually one limb or one half) -Stambha (stiffness), Shaithilya (flaccidity), Ruja (pain) -Decreased function of affected limb -Sparsha-hani (loss of sensation) -Vak vikara (speech difficulty – if associated with Pakshaghata) -Manda cheshta (sluggish or no movement) ( Reference: Charaka Samhita, Chikitsa Sthana 28/43 Madhava Nidana 22/11) 🔺 SYSTEMIC EXAMINATION (MODERN CLINICAL APPROACH) A.Neurological Examination -Motor Function: -Muscle power (using MRC scale) -Tone (hypotonia in LMN lesion, hypertonia in UMN lesion) 📌Reflexes: -Superficial (plantar reflex – Babinski sign) -Deep tendon reflexes (exaggerated in UMN lesion) 📌Sensory Examination: -Superficial (pain, temperature, touch) -Deep (vibration, proprioception) -Cortical (2-point discrimination, stereognosis) -Cranial Nerve Examination: To rule out associated stroke or brain lesions -Cerebellar signs (if cerebellum involved) 📌Cardiovascular Examination -Auscultation for murmurs or arrhythmias (AF may lead to embolic stroke) 📌Respiratory & GI Systems -Usually unremarkable unless systemic disease (e.g., tuberculosis, vasculitis) 🔺 LABORATORY INVESTIGATIONS -Blood Tests -CBC: May show infection or anemia -ESR/CRP: Raised in inflammatory or autoimmune disorders -Blood sugar levels: Rule out diabetic neuropathy or stroke in diabetes -Lipid profile: Risk of atherosclerosis -Coagulation profile: If stroke suspected -Thyroid Function Test: Hypo/hyperthyroidism may affect neuromuscular function 📌Imaging -MRI Brain/Spine: -To detect infarct, hemorrhage, tumor, multiple sclerosis, demyelination 📌CT Scan Brain: -For acute stroke, hemorrhage 📌Nerve Conduction Studies (NCS)/EMG: -To differentiate upper vs. lower motor neuron lesions -Assess nerve or muscle involvement 📌 Others (if needed): -Autoimmune Panel: ANA, anti-dsDNA for autoimmune causes -CSF analysis: If infection or demyelinating disease suspected 📌 Expected Results In Ekangavata -MRI Brain : Ischemic or hemorrhagic lesion in motor cortex/internal capsule -NCS/EMG : Normal in UMN lesions, abnormal in LMN -Reflexes :Hyperreflexia (UMN), Hyporeflexia (LMN) -Babinski sign : Positive (UMN lesion) -Muscle Tone : Spasticity (UMN), Flaccidity (acute phase or LMN -Blood Sugar : May be elevated if diabetes is a risk factor 🛑https://chat.whatsapp.com/JtHGdxv7A5SA9bAe8ZNIS2