Monday, December 25, 2006

A Case of Astrocytoma Grade 4


This case came to me when the disease had progressed so much from where there was no chance of recovery. But I had to at least relieve the patient of his sufferings to whatever extent it was possible so I took up the case.

Ill tell what I saw when I went to see the patient. It was a picture of total calm the patient was laying on his bed. There was a vacant expression on the face and there was no expression of pain as I had anticipated .His pupils were not reacting to light he looked sleepy and drowsy. This expression left a deep impression on me and I made the necessary notes and went on with the case taking.

The patient had undergone a craniotomy and the tumor in the cerebrum in the left temporal lobe was partially removed. The patient was responding well after the surgery. Then the patient had to undergo the radiations as advised by the oncologist but the patient was strongly against undergoing the same. But he had no other option as family members and everyone convinced him about the same.

After completion of the 20th radiation the patient started deteriorating. First the right hand right leg got paralyzed. And the paralysis was gradually developing. There was also complete loss of voice. This happened within a span of 5 month after the surgery. On repeat C.T scan there was a large hyper dense lesion in the left temporo-parietal region.

The other complaints were severe constipation and stools had to be mechanically removed and they were like small balls. The stools were black in color. There was great difficulty while passing them. Also there was complete loss of appetite. There was a delusion that people are talking loudly and fighting.

Earlier there was severe headache when the lesion was detected for the first time with projectile vomiting. But now the patient is calm, doesn’t say anything, and there was a vacant feeling on the face.

The patient came from a small village in Maharastra India .He was an agriculturist and had a big farm. By nature he was very industrious in his village he had brought the latest things in agriculture .He also advised the other small time farmers what they have to do to reap a good harvest. He used to help them and was very compassionate by nature.

During the famine in their village for 3 consecutive years he helped most of the people as he had 4 wells that had water even during the famine and was the main source of water to the people in the village and their animals. He incurred financial loses but felt it was his duty to help them as they had no other option.

Sometimes he used to be sad when he thought about the famine and used to sit alone and think about the situation. When his cow died he felt a big shock and also his son was also very ill. These things affected him a lot as per the family members.

He was quite by nature didn’t talk much but was very intelligent he had learned most of the things right from repairing a stove to repairing the complex electrical motors. He provided his expertise without charging a penny. Financially they were very good.

He was the appointed head of his village and the government had given him special powers because of his honesty and helping nature towards the poor people.

The other thing that was told was that whenever he got angry he would just keep quite, stay alone and if someone consoled him he felt better. There was no revengefulness and he forgave the person easily.

During childhood he was a quite child very attached to his mother. Father was very strict but he was very attached to him. His father was an educationist and had started many schools at the district level. His childhood was good and he was very good in his studies he used to stand first in the class. He had a problem of stammering during the childhood.

His married life was also very good. Good relation with his wife and children. His mother passed away immediately after his marriage when he heard the news of her passing away in an accident he became unconscious and then for 1 month he developed headaches and giddiness. His father passed away due to old age. This also affected him a lot.

He was very particular about his work whatever task he took he completed it properly and in time. He didn’t like to waste time and expected the same from others.

The above details were taken from the family members.

Personal history

Diet: Vegetarian

Appetite: very low

Craving: Sweets +2, Spicy food +2

Thermals
Fan: Aversion as it caused nose block
Covering: takes covers
Bath: warm water
Sun: didn’t cause any problems.

Stools: Severe constipation, ball like hard black in color.

Urine: involuntary passing of urine

Perspiration: forehead

Sleep: patient sleeps most of the time and is drowsy

Investigation
Computerized tomography scan (C.T.Scan) before surgery
A large predominantly non enhancing lesion showing necrosis and measuring about 38x 36 mm with small foci of enhancement and ring enhancement seen in the left temporal lobe. The lesion is seen extending upwards to the fronto-parietal region and protruding through the bone defect associated with gross edema and displacing the structure to the left side. There appears to be no subfalcine extension except due to edema. No evidence of calcification or hemorrhage is noted.

Posterior fossa: Cerebellum appears normal .4th ventricle appear normal

Supratentorial: Cerebral parenchyma on the right side grossly appears normal. Basal cisterns are normal.

Cortical cisterns show obliteration on the left side and effacement on the right side.3rd ventricle and lateral ventricle shows pressure effects. Basal ganglion on the right side is normal and on the left side shows involvement with edema. Midline shift of 12mm towards right is seen.

Imp: 1st possibility: Anaplastic Astrocytoma
2nd possibility Glioblastoma multiforme

6 months after Surgery and radiations

C.T.Scan
A large hyper dense lesion is seen in the left temporo-parietal region showing minimal vasogenic white matter edema causing effacement of the ventricles on the same side and minimal shift of the midline structures to the opposite side showing peripheral contrast enhancement and central necrosis.

? Gliomas (possibly high grade Glioblastoma) Evidence of small hemorrhage in left temporo-parietal region

Histopathology report: Astrocytoma grade 4

On examination
The patient was not responding to anything there was a vacant look on the face.
The pupils were dilated and non reactive to light. There was occasional movement of the body.
Wasting of the lower limbs was noted. Swelling on the lower limbs
B.P: 110/70 mm of Hg
Respiratory system: Nad
Cardiovascular system: Nad



2/2/05

Rx
1) Opium 30
1 dose stat

2) Sac-lac 1-0-1
For 7 days

19/2/05
Stools are better there is less discomfort while passing them.

Started taking proper food in the evening

Sleeps throughout the day

Fever in the evening 5pm-6pm

The other leg has also started becoming heavier
Rx
1) Sac.lac
1-1-1

2) Sac.lac

3 powders for 3 nights

For 14 days


23/3/05
Swelling of the leg is better.
No fever
Has started to communicate by making gestures
Tries to talk but voice is too weak
Wanted to walk
Stools are normal
Eats well now
Urine output has increased

Rx
Continue all for 14 days

The patient was improving steadily but then suddenly he developed lower respiratory tract infection along with high-grade fever. On x-ray there was pleural effusion.

The patient was put on antibiotics but the patient failed to recover and his condition deteriorated and I got a call one morning that the patient passed away in the morning.

I was informed about the above condition when it was too late.

Learning

The homeopathic medicines are deep acting remedies as we saw how even in this pathologically advanced case when the laxatives and other medicines where unable to give relief to the patient .The correct homeopathic remedy helped the person to get relief.

We can achieve at least palliation in its right term and relieve the suffering of the terminally ill patients.

Dr.Santosh Joshi who practices Classical Homeopathy in Mumbai India treated the above case.

Email me on : tosh116@gmail.com for more details and consultation


For information on Glioblastoma multiforme click the following link.

http://en.wikipedia.org/wiki/Glioblastoma_multiforme

1 comment:

Manjari said...

very well done tosh !!!