NHR Oct-Dec 2018: Case Report: Homoeopathic Treatment of Calcified Granuloma of Brain

Homoeopathic Treatment of Calcified Granuloma of Brain: A Case Report


Aniruddha Banerjee*1, Birendra Prasad Srivastava2

  1. Postgraduate Trainee, Dept. of Case Taking and Repertory, National Institute of Homoeopathy, Govt. of India
  2. Professor, Dept. of Case Taking and Repertory, National Institute of Homoeopathy, Govt. of India

*Correspondence: draniruddhabanerjee@gmail.com


Abstract

Granuloma of the central nerve system is the most common radiological abnormality found in patients with acute onset seizures. Neurocysticercosis (NCC) and tuberculoma are the most common causes of this granuloma. A case is presented in this paper with radiological evidence of single ring enhancing lesion in the right frontal lobe with a thick and irregular wall. Malignancy and HIV were excluded. The patient was treated with constitutional homoeopathic medicines – Tuberculinum bovinum 0/1, 16 doses, followed by Pulsatilla nigricans 0/1 – 0/5, 16 doses each. Follow-up imaging at 3 months showed complete resolution of the calcified granuloma. This case report suggests homoeopathic treatment as a promising complementary or alternative therapy and emphasizes the need of repertorization in individualized homoeopathic prescription.

 

Keywords: Brain granuloma; Quality of life; Homoeopathy; Case report


Introduction

Granuloma  of   the  central  nervous  system  is  one of the  most  common  radiological  abnormalities  seen  in  the patients  with  acute onset seizures in India and many other developing countries.  Neurocysticercosis (NCC) is the most likely cause of this granuloma. A single degenerating cyst is the most frequent finding associated with NCC in the Indian subcontinent [1]. Single cysticercus granuloma is one which measures  less than 20  mm  in  diameter,  may  be  associated  with  cerebral  edema  not  severe  enough  to  produce  midline  shift,  and  occur  in  patients  with  seizures  and  normal  neurological  status,  without  evidence  of   active  systemic  disease. When this granuloma resolves spontaneously, it either disappears or changes into a calcified nodule, and the diagnosis of NCC is very likely. The second most common cause of computed tomography (CT)-detected granuloma is tuberculoma. In patients with this granuloma, similar clinical and neuro-imaging features are also present. Granuloma visualized on CT scanning is the most common radiological abnormality in Indian patients with new-onset seizures [2]. In 1980, Tandon and Bhargava [3] first reported these lesions; at that time these CT-enhancing lesions were presumed to be tuberculoma and often were treated with empirical anti-tubercular drugs. Subsequently, histopathological studies of brain tissue biopsy samples have suggested that,  in majority, CT-enhancing lesions represent dying cysticercal lesions (larval stage of  tapeworm Taenia solium) [4]. In India, both tuberculosis and cysticercosis are common; hence difficult to differentiate between tuberculoma and a cysticercal granuloma. Some granulomas “heal” by becoming calcified. These patients present with headache and other symptoms, symptomatic therapy is instituted [5].

Evidences in support of individualized homoeopathic treatment of calcified granuloma of brain remains compromised; only a single case report could be identified after a careful search in different electronic databases [6]. Here another case report is presented.

 

Case proper

A female patient, aged 25 years, residing Ghaighata, West Bengal came to the outpatient department of National Institute of Homoeopathy on February 1, 2016 (OPD No. 10152/16) with complaints of pain and heaviness of whole head since 6 months with burning in eyes and dizziness of vision, associated with seizures since 6 years which were aggravated after 2-3 months of delivery. There was a concomitant symptom of cough with difficulties in breathing since 6-7 years.

History of present complaints: Onset gradual, duration 6 yrs, headache aggravates while thinking, cough and dyspnoea aggravates at night and early morning, history of allopathic treatment without any remarkable improvement.

Past history: Pneumonia at the age of 5 years

Family history: Brother having breathing difficulty (Tuberculosis?).

Physical generals:

  • Appetite less, does not like to eat especially in the morning, feels heavy.
  • Thirst less, drinks little in long intervals.
  • Desire for spicy food, fatty food, meat.
  • Aversion to sweet.
  • Urine frequent, burning while urination, offensive.
  • Stool constipated, 1-2 day’s interval.
  • Sleep deprived, only by taking sedatives.
  • Dreams of flowing water.
  • Tongue dry.
  • Thermal reaction ambithermal, burning of whole body.
  •  Menstruation irregular, stays for 3-4 days; leucorrhoea before menses.
  •  History of Mantoux test Positive (Jan 9, 2016)
  • Developmental milestone delayed.

Mental generals: Weeping disposition, fear of darkness, fear of dog, wants to be alone all the time, easily forgetful, usually extroverted.

Totality of Symptoms [7]:

  • Fear of dog.
  • Fear of darkness.
  • Easily forgetful.
  • Tendency to catch cold easily.
  • F/H of Tuberculosis.
  • Delayed milestones.
  • Desire for meat, fatty food.

Prescription: Tuberculinum bovinum, 16 doses in100 ml aqua dist, one dose every morning in empty stomach. But after completion, no improvement was observed. So the case was retaken, followed by evaluation & repertorization.

Timeline: Radiological imaging was done twice during the period of treatment, on January 11, 2016 and April 13, 2016.

C. T. scan of brain on March 31, 2015 shows calcified granuloma in rt. frontal region of brain MRI of brain (plain study) on Jan 11, 2016 suggesting calcifying granuloma or tuberculoma at rt. superficial frontal region
C. T. scan of brain on April 13, 2016 showing normal study

 

Evaluation of symptoms:

  • Mental General: Weeping disposition, fear of darkness, sensation as if limb is absent.
  • Physical General: Thirst less, drinks little in long intervals; Desire for spicy food, fatty food, fish; Thermal reaction ambithermal; burning of whole body

Characteristics particular: Pain and heaviness of whole head since 6 months with burning in eyes and dizziness of vision.

 

Repertorial sheet:

 

This case was repertorized by using the software RADAR®, using Kent’s Repertory [7]. The reportorial results were analyzed giving more importance on the mentals as well as physical general symptoms than particular symptoms for selection of medicine. Pulsatilla nigricans 0/1 was prescribed, 16 doses in100 ml aqua dist., one dose in empty stomach every morning. Then in subsequent follow-ups from Feb. 15, 2016 to April 17, 2016, potency was gradually increased up to 0/5 with gradual improvement in symptoms with a general improvement.

Assessment by Modified Naranjo score:

Items Yes No Not sure /NA
1.        Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed? +1
2.        Did the clinical improvement occur within a plausible time frame relative to the drug intake? +1
3.        Was there an initial aggravation of symptom? 0
4.        Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed? +1
5.        Did overall wellbeing improve? 0
6.        Did the course of improvement follow Hering’s Rule? +2
7.        Did old symptoms (non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement? 0
8.        Are there alternate causes (other than the medicine) that-with a high probability could have caused the improvement? (e.g. known course of disease, other forms of treatment and other clinically relevant intervention) +1
9.        Was the effect confirmed by objective evidence as measured by external observation(s)? +2
10.     Did repeat dosing, if conducted, create similar clinical improvement? 0

The final causal attribution score in this case was assessed using the Modified Naranjo Criteria, as proposed by the HPUS Clinical data Working Group, June 2014 [8]. The total score was 8, thus suggesting a ‘probable’ association between the medicine and the outcome [definite: ≥ 9; probable 5-8; possible 1-4; and doubtful ≤ 0]. Reporting of this case adhered to the Hom-CASE-CARE guideline [9].

Conclusion

A case presented with radiological evidence of single ring enhancing lesion in the right frontal lobe with a thick and irregular wall. The patient was treated with constitutional homoeopathic medicines – Tuberculinum bovinum 0/1, 16 doses, followed by Pulsatilla nigricans 0/1 – 0/5, 16 doses each. Follow-up imaging at 3 months showed complete resolution of the calcified granuloma. This case report suggests homoeopathic treatment as a promising complementary or alternative therapy and emphasizes the need of repertorization in individualized homoeopathic prescription. Totality of symptoms gives the clue about the selection of medicine which has resemblance to the Potential Differential Field (PDF), but sometimes it may mislead the plan of treatment. At this point, repertorization is needed for treating the cases in better way.

References

  1. Rajshekhar V. Etiology and management of single small CT lesions in patients with seizures: Understanding a controversy. Acta Neurol Scand.1991; 84:465-70.
  2. Kumar Garg R, Kumar Singh M, Misra S. Single-enhancing CT lesions in Indian patients with seizures: A review. Epilepsy Res. 2000; 38:91-104.
  3. Tandon PN, Bhargava S. CNS tuberculosis lessons learnt from CT studies. Neurol India. 1980; 28:225-30.
  4. Rajshekhar V, Oommen A. Serological studies using ELISA and EITB in patients with solitary cysticercus granuloma and seizures. Neurol Infect Epidemiol. 1997; 2:177-80.
  5. Harrison’s text book of Internal medicine. 20th New York, Churchill Livingstone Elsevier, 2007.
  6. Purkait R, Panakkada D. Successful treatment of calcified granuloma of brain by individualized homoeopathic medicine: A case report. National Homoeo Recorder. 2018;14(2):28-32.
  7. Kent JT. Repertory of the Homoeopathic Materia Medica and a Word Index. Enriched Indian Edition. Reprinted From 6th American Edition, Edited and Revised by Kent CL, Low Priced Edition. New Delhi; B. Jain Publishers Pvt. Ltd., 2005.
  8. Rutten L. Data collection: Treat every variable as a treasure. Homeopathy. 2015;104(3):190-196.
  9. Van Haselen RA. Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med. 2016; 25:78-85.

Consent for publication: A written consent for publication had been obtained from the patient.

Funding: None

Conflict of interest: None

Acknowledgements:  The authors acknowledge the patient for her cooperation.


Cite this article as: Cite this article as: Banerjee A, Srivastava BP. Homoeopathic treatment of calcified granuloma of brain: A case report. National Homoeo Recorder 2018;14(4):55-59.

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