Bell’s palsy..brief ppt

ARDITA VATA

By Shabana Parveen

HISTORICAL REVIEW OF ARDITA

VEDIC KALAThere is no specific reference found regarding Ardit in any of the vedas.

SAMHITA KALA (200. B.C.- 400 A.D.)Samhita granthas consists of detailed decription regarding Ardit,

CHARAK SAMHITA (2nd Century B.C.)Ardit is considered among eighty Nanatmaj Vatavikaras (Ch. Su. 20/11). It is also described as the disease of Madhyam Roga Marga. i.e. Marm-Asthi-Sandhi Marga

involvement of unitateral limbs as well as face. (Ch. Chi. 28/36-40)

Chakrapanidatta (11th Century) clarifies the differentation between Ardit and

Pakshavadha by explaning Ardita as “Vegitaya Na Sarvakala” and and Ardhangatata as “Sarvakalo Vyapya”

SUSHRUT SAMHITA : (2 A.D.) The first chapter of Nidanasthan, deals with

Nidana, Rupa and Asadhyata of Ardit. Ardit is described indicating involvement of unilateral face only. Sushruta has given specific line of treatment for Ardit

MADHAV NIDANA (7th Cen.)It is said that “Nidane madhavashreshtha” in praise of Madhavanidana. Ardit has been described with causative factors, pathogenesis, signs and symptoms as well as prognosis,in the chapter 22nd Vatavyadhinidanam.

SHARANGDHARA SAMHITA (13th Cen.)Ardita has been enumerated among eighty-vata-nanatmaj disorders.

BHAVAPRAKASH (16th Cen.)Bhavaprakash has described types of Ardita separately with specific line of treatment for it.

ETYMOLOGY The word ‘Arda’ means to afflict, torment, strike,

hurt, kill etc. ‘Ardana’ means distressing, afflicting, pain,

trouble, anxiety, exitement, agitation, killing, hurting, giving pain, etc.

word ‘Ardit’ is suffered or affected, likewise, suffering from pain, shula, hikka, swasa etc.

Charakasamhita describe it with involvement of unilateral limb & face.

while Sushruta samhita made a specification for it,only related to face.

NIDANA “Garbhene suthikabala vruddikshene vyasruk kshaye

Uchayvyar haratho asyartham kadathah katinani cha ”

The pregnent women, women after delivery, children, old persons,the debilitated anaemic persons, those who speak loudly, eat hard foods, laughing, yawning,weight lifting, improper posture in bed.

SAMPRAPTHI GHATAKAS

Dosha Vata꞉Dushya Rasa,raktha,mamsa꞉Srothas Rasa,raktha,mamsa ꞉Srothodusti Atipravritti꞉Udbhava sthana Urdhwa jathru꞉Vyaktha sthana Urdhwa jathru꞉Roga marga Madhyama ꞉

PURVA RUPA“Yasyagrajo romaharshe vepayurnetramavilam,

Vayururdhva tvachi svapasthadho manyahanugraha”

Roma harsha (horripilations)Vepathu (tremors)Netra avilam (turbidity of the eyes)Vayu urdhvam (upward movement of eyes)Manya graham (catching pain in shoulder)Hanu graha (catching pain in lower jaw)

RUPA“Vakribhavathi vakrardham griva chapyaparvarthathe

Sirschalathi vaksango netradinam cha vaikrutham”

Mukha vakrata (deviationof one side of mouth)Greeva chapya (Neck deviation)Sira chalati (tremors of the head)Vak sanga (speech impairement)Vaikrta nertradi (inability of closure of eyes,eyes brown deviation etc).

According to charakaDifficulty in eatingNetra stabadamKshavadhu nigruhyataDanta chalaSwara bedha

According to SusruthaArdita in emaciated persons, who don’t wink their eyes,whose speech is slurred.Whom it is persisting for more than 3years is incurable.

PATHYAOushadha:Sad bindhu tailaBhunaga tailaSigru bija tailaVisa tinduka vati

Ahara:Milk boiled with Pancamula,Juice of sour fruitsSoups of meat & corn.Fatty & salty foods.

VIHARA Pouring liquids on the body containing

leaves of Kumkuma, Agaru,Kusta, Ela, Tagara body covered with Silk,wool, cotton.

Residing in places with mild breeze and sunlight.

Use of soft bed, Maintaining celibacy.

APATHYAAHARA

Unwholesome diets of vata vyadi:-Gram,Peas,Nirvaara,Kuruvinda and varieties of Paddy and Flour obtained from kodruva and Syama grains.Others like Milk,Barely, Leafy vegetables,Dried meat,Honey,Citrus,Sour & bitter eatablesWater from Ponds,Rivers & Contaminated waters.

VIHARAHarmful activities for the patient of vata vadhi disease include:- Worrying Remaining waked

upto late night Suppression of

natural urges Vomiting Langana Sexual intercourse

Blood letting, Lying idle for hours, Walking a lot, Bathing, Rubbing the teeth

‘Nidana-parivarjana’ by Sushruta samhita (Su. Utt. 1/25)

While Vagbhatta provokes that disintegretion of Samprapti is Chikista.

The general treatment principle of Vatavyadhi is mentioned before, among which ‘Snehana’ is main tool.

CHIKITSA OF ARDITA

Specific treatment of Ardita stated in Sushruta is –

Mashtishkya, Shirobasti Nasya Dhum Upanah Sneha Nadisweda, etc.

A formula of kshirataila is also given and indicated for Pana, Abhanga, etc.Akshitarpanam by kshirsarpi is also suggested

(Su. Chi. 5/22).(28)

As per Charaka:

Tailas:-For Nasya Anu taila Shad bindu taila Ksheera bala tailam Bhunaga tailam Maharaja prasarini

tailam

Murdhina taila over head

Abhyanga Seka Pichu Siro-vasthi

are also mentioned.

Similarly, Navana & Moordhnitaila are indicated by Ashtang Sangraha & Astanga Hridaya.

Specific indication of Vamana and Siravyadha are also found (A.H.Chi.21/43, A.S.Chi. 23/10).

Bell’s Palsy

By Shabana Parveen

Oh my God I’m having a Stroke

You wake up one morning, and your face feels stiff and odd. When you look in a mirror, half your face appears to droop. You can only manage half a smile, your eye is dripping tears and doesn't want to close. What in the world is going on?

No silly it’s Bell’s Palsy

If your muscle weakness or paralysis affects only your face, a more likely cause is Bell's palsy.

Defined as temporary facial paralysis Trauma or damage to the 2 facial nerves

Who is this Bell guy?

Charles BellWell known for his studies on the nervous

system and the brain In the 19th century discovered that lesions of

the 7th cranial nerve causes facial paralysis

HOW COMMON IS BELL'S PALSY?

Bells palsy is not as uncommon as is generally believed. Worldwide statistics set the frequency at just over 0.02% of the population (with geographical variations).

In human terms this is 1 of every 5000 people over the course of a lifetime.

IS BELL'S PALSY ALWAYS ON THE SAME SIDE?

The percentage of left or right side cases is approximately equal, and remains equal for recurrences.

ANATOMY OF FACIAL NERVE The 7th cranial nerve is paired

with thestructure that travels through a narrow, bony canal (called the Fallopian canal) in the skull

beneath the ear to the muscles on each side of

the face. The nerve is mostly encased in

this bony shell.

FACIAL NERVE PHYSIOLOGY

Each nerve controls: Eye blinking and closing Facial expressions

Smiling and frowning

Tear glands Saliva glands Muscle of small bone in middle of ear called the

stapes Taste sensations

Etiology Mostly unknown May be caused by a viral infection

Viral meningitisHerpes simplex

Influenza Headaches Chronic ear infections High blood pressure Diabetes Sarcoidosis Tumors trauma

Idiopathic facial palsy (Bell's Palsy) Most common cause of facial paralysis (>50%

of case) Most age 25-30 yrs. Male : Female = 1 : 1 Left side : Right side = 1 : 1 Unilateral > bilateral Increase risk in

pregnancy 3.3 times DM 4.5 times

Recurrent rate 10%

SIGNS & SYMPTOMS

Varies from person to person Comes on suddenly Mild to total paralysis

Weakness, twitching on one of both sides of the face

Facial and eyelid droop Drooling Dryness of eye or mouth Impairment of taste Excessive tearing of eye

Other S/S

Pain or discomfort in jaw and behind the ear Ringing in one or both ears Loss of taste Headache Hypersensitivity to sound Impaired speech Dizziness Difficulty eating and drinking

Sunderland classification of nerve injury

1° damage = Compression

2° damage = Interruption of axoplasm

3° damage = Disruption of myelin

4° damage = Disruption of perineurium, myelin and axon

5° damage = Transection of nerve

Physical examination

ENT exam Nervous system Location Severity

There are no specific lab tests to confirm diagnosis Will exam for upper and lower facial nerve

weakness Electromyography MRI and CT

INVESTIGATIONS

Differential Diagnosis

Ramsay Hunt Syndrome Type – 2 Lyme Diseases

Treatment Corticosteroids :

prednisolone 1 mg/kg/day 7-10 days Corticosteroids combine with antiviral drug

is better Acyclovir 400 mg 5 times/day Famciclovir and valacyclovir 500 mg bid

Surgical treatment Surgery is treatment of choice for :- Facial nerve decompression

Indications for facial nerve exploration incomplete paralysis iatrogenic paralysis

Appropriate time for surgery is 2-3 weeks after paralysis

Contraindications : any case have no poor prognostic factors

Treatment Cont.

Hard to close eyeUse and eye patchEye dropsTape eye shut when sleeping

Complications Complications of facial nerve

decompression Dripping tearsconductive or sensorineural hearing lossvestibular function losspersistent CSF leaksmeningitisinjury to the anterior inferior cerebellar

artery (AICA) or its branches

When does it go away?

Outcome is good!!! Total recovery depends on amount of damage to nerve Improvement is gradual Usually start to get better after 2 weeks of onset and

most recover completely within 3 to 6 months. In a few cases, the symptoms may never completely

disappear. In rare cases, the disorder may recur, either on the

same or the opposite side of the face.