|Year : 2020 | Volume
| Issue : 3 | Page : 99-102
Management of hemangioblastoma of brain with Ayurveda and Yoga: A case report
Umesh Kumar Sapra, Ravikant Sharma
PG Department of Roga Nidana Evam Vikriti Vigyana, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, India
|Date of Submission||19-Aug-2020|
|Date of Acceptance||07-Dec-2020|
|Date of Web Publication||18-Jan-2021|
Dr. Umesh Kumar Sapra
PG Department of Roga Nidana Evam Vikriti Vigyana, Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi - 110 073
Source of Support: None, Conflict of Interest: None
Hemangioblastoma is a benign, highly vascular tumor that can occur in the brain, spinal cord, and retina. This tumor accounts for about 2–3% of brain tumors. As it expands, it creates pressure on the brain and can cause neurological symptoms such as headache, weakness, sensory loss, impaired balance and co-ordination, and/or hydrocephalus. In this case study, a middle-aged female patient, a known case of multiple cystic lesions (hemangioblastoma) in brain with ventriculoperitoneal shunt, presented with weakness of legs, giddiness, stiffness in body, and difficulty in speech for eight years. The first Magnetic Resonance Imaging (MRI) of brain was done in 1997 which revealed chronic hydrocephalous with superadded atrophic changes and cystic lesion in the region of left foramen of luschka. The patient was treated on the line of Aavranajanya vata vyadhi. Ayurvedic medicines along with Yoga therapy was advised and continued for ten months. The patient showed marked improvement in the clinical signs and symptoms. Brain MRI of the patient also showed decrease in the size of the lesion as compared to the previous scan.
Keywords: Aavarana, cystic lesion, hemangioblastoma, Vata vyadhi, Yoga
|How to cite this article:|
Sapra UK, Sharma R. Management of hemangioblastoma of brain with Ayurveda and Yoga: A case report. J Ayurveda Case Rep 2020;3:99-102
|How to cite this URL:|
Sapra UK, Sharma R. Management of hemangioblastoma of brain with Ayurveda and Yoga: A case report. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Feb 28];3:99-102. Available from: http://www.ayucare.org/text.asp?2020/3/3/99/307223
| Introduction|| |
Hemangioblastoma is a rare low-grade neoplasm (WHO Grade I) of uncertain histogenesis, characterized by the proliferation of closely packed capillaries admixed with large neoplastic stromal cells; it most commonly arises in the cerebellum and less frequently in the brain stem, spinal cord, and supratentorium. This tumor accounts for about 2–3% of brain tumors. The majority of them occur sporadically. However, some people develop it as a part of genetic syndrome called Von Hippel–Lindau (VHL) syndrome. Magnetic Resonance Imaging (MRI) with contrast enhancement is the imaging procedure of choice to diagnose the tumors of brain.
Vata vyadhi (~neuromuscular disorders) get the prime importance in Ayurvedic classics. The causes of Vata vyadhi are described in Ayurvedic texts as Dhatu kshaya (~decrease of tissue) and Aavarana (~covering). Aavarana is a unique concept of disease formation, especially of Vata vyadhi. The exact meaning of Aavrana is covering. All the Dosha (~bodily bio-elements) have a normal Shakha-kostha gati (~movement) which when maintained are able to perform their normal functions. Vata dosha is the chief among Tridosha because of its “Aashukaritva” (~spreads quickly/quick acting) and its ability to carry on all the life processes in association with Pitta, Kapha, Sapta dhatus (~seven types of bodily tissue), and Trividha malas. It is composed of Rajoguna which is the “Pravartaka-sarvabhavanam” (~initiates all factors) and the other two Doshas often described as “Pangu” or lame without the involvement of Vata dosha. Hence, its Gati (~movement) is very important. If Vata dosha gets Aavrita or Vimarga aashrita, various disease processes can begin in the body. This was a chronic case suffering from cystic lesion in the brain (hemangioblastoma). In the current case, the patient was treated on the line of Aavaranajanya vata vyadhi. The condition was compared with Prana aavrita samana vata.,, This case can help Ayurvedic physicians to explore the possibilities of the management of hemangioblastoma with Ayurvedic medicines on an outpatient department (OPD) basis.
| Case Report|| |
A 47-year-old female homemaker, a known case of multiple cystic lesions (hemangioblastoma) of brain with ventriculoperitoneal shunt (VP shunt), came to the OPD of Roga Nidana department with complaints of weakness of legs, giddiness and stiffness in the body, and difficulty in speech for eight years. MRI of brain revealed multiple cystic lesions with VP shunt. According to the patient, she was asymptomatic 16 years back. Later, she suddenly started to have mild headache and giddiness. She was treated with analgesics at Deendayal Upadhyaya Hospital, New Delhi, and her symptoms subsided. Then after a few days, she had an episode of headache, for which she had undergone Computed Tomography (CT) and MRI (brain) scan and was diagnosed as multiple cystic lesions in the region of cisterns with chronic hydrocephalous and past VP shunt. She had suggestion treatment but relief was not found. From 2005, she had complained of weakness of legs, giddiness and stiffness in body, and difficulty in speech, for which she had taken allopathic treatment for eight years but did not get satisfactory result.
Symptomatic cerebellar or brainstem hemangioblastomas are typically treated by surgical removal through a sub-occipital or retromastoid craniotomy. The patient consulted a neurosurgeon at Deendayal Upadhyaya Hospital, New Delhi, and was advised surgery, but the patient refused the advice. In 2013, the patient decided to take Ayurvedic treatment. The patient had no history of diabetes mellitus/hypertension/chronic obstructive pulmonary disease/coronary artery disease/hypo-hyperthyroidism. No family history of brain lesion/stroke was observed. On inquiry, the patient was constipated with low appetite, normal micturition, and sound sleep.
The patient had Vata kapha prakriti (~psychosomatic constitution) with Madhyama koshtha (~moderate nature of alimentary tract), Mandaagni (~decreased digestive fire), and Heena bala (~least physical strength). On examination, blood pressure of the patient was 110/68 mmHg and pulse rate was 76 beats/min. The patient was afebrile. Pallor, icterus, clubbing, edema, and cyanosis were absent. Texture of the skin was smooth.
Respiratory, gastrointestinal, and cardiovascular system examinations showed normal findings. On central nervous system examination, the patient was conscious and well oriented with respect to time, place, and person with impaired speech. Memory of the patient was good. Gait was ataxic. All cranial nerves were intact. Muscle power of the patient before and after treatment is summarized in [Table 1].
The patient underwent multiple CT scan and MRI scan (on September 19, 1997), which revealed chronic hydrocephalous with superadded atrophic changes and cystic lesion in the region of left foramen of luschka, which also appeared to obstruct the 4th ventricle and probably extending into the Cerebellopontine Angle (CPA) cistern which on left was dilated accompanying brainstem compression. Later, MRI of the brain on September 22, 1997, showed cystic hemangioblastoma with marked obstructive hydrocephalous. Further MRI of the brain on November 9, 1997, showed shunt in the right lateral ventricle. There was reduction in the size of the lateral and third ventricles. There was no change in the size, shape, or character of the cystic lesion in the infratentorial compartment. The lesion was likely to be a cystic hemangioblastoma or epidermoid. Then, again, on March 30, 2010, MRI of brain was done which revealed multiple cystic lesions in the region of cisterns. Further MRI of brain on September 10, 2013, revealed no significant interval change. All these findings were observed before the start of the treatment.
| Timeline|| |
The patient was treated on the line of Prana aavrita samana vata. Treatment prescribed to the patient is mentioned in [Table 2]. Along with ayurvedic Ayurvedic, Yoga therapy such as Anuloma-viloma, Dhyana mudra (it is a hand gesture that takes the mind to a deeper level of meditation), and Prithvi mudra (it is a symbolic hand gesture used in yoga to promote healing and spiritual balance within the body) for 15–20 min/day for ten months was also advised.
| Follow-up and outcome|| |
After treatment, the patient was followed up for three months, and she was recovering well. After the treatment, the gait of the patient was found improved. The effect of the medicines on the muscle power in the upper and lower limb is described in [Table 1]. MRI of brain on June 26, 2014, showed (in comparison to previous MRI done on September 10, 2013) decrease in size of the left CPA extra-axial lesion as well as mass effect.
| Discussion|| |
Aavarana is a unique concept of disease formation. The exact meaning of Aavarana is covering. The cause of Vataprakopa is Dhatu kshaya and Aavarana. This is a case report of Aavarana janya vata vyadhi, especially Prana aavrita samana vata. The treatment of Aavarana janya vata vyadhi should aim toward cleansing the Srotas (~minute channels in the body) with different kinds of medications or therapies which are not antagonistic to Kapha and Pitta, but which cause Vatanulomana (~downward movement of Vata). This treatment should be conducted with Anabhishyandi dravya, which does not cause obstruction to Srotas and helps in the cleaning of channels of circulation. Drugs that contain Bhallataka (Semecarpus anacardium Linn), Rasona (Allium sativum L.), Guggulu [Commiphora wightii (Arn.)], Pippali (Piper longum L.), and Shilajit (Asphaltum punjabianum) are very useful in removing Aavarana. Use of Rasayana such as Shilajit, Ashwagandha [Withania somnifera (L.) Dunal], Gokshura (Tribulus terrestris L.), and Guggulu along with milk is beneficial for increasing the strength of patients. Rasamanikya is the classical Rasa preparation having Hartala (~orpiment) as the main content. It helps to remove the toxins (~Amavisha) from the blood in patients with Kapha dominance. Rasamanikya is also helpful in Amavisha and Vata-kapha diseases of female patients.
The patient in this case was administered Kanchanara guggulu, Goksuradi guggulu, and Punarnavasava to subside the Granthi/Shotha (~mass/swelling). Madhuyashti powder, Ashwagandha powder, Saraswatarishta, and Ashwagandharishta were given for Medhya and Rasayana effects. Dhatri lauha was given to treat the Pandu. Brihat majishthadi kwatha was given to clear the Rakta and Rakta vaha srotodushti or Aavarana. Anuloma-viloma removes toxins (~Amavisha) from the body. It also helps in balancing and relaxing the nervous system. Dhyana mudra and Prithvi mudra help to make the body and mind more stable and concentrated.
| Conclusion|| |
Based on signs and symptoms, hemangioblastoma in brain can be correlated with Prana aavrita samana vata described in Ayurvedic literature. Ayurvedic medications along with Yoga therapy are beneficial in the management of the disease. This case study demonstrated the successful management of symptoms related with multiple cystic lesions (hemangioblastoma) in the brain by Ayurveda.
Declaration of patient consent
The authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jalikis FG, Hoch BL, Bakthavatsalam R, Montenovo MI. Sporadic retroperitoneal hemangioblastoma: Report of a case and review of the literature. Hindawi 2017; 2017:1-5.
Temprano T, Fernandez-de LR, Rial JC, Fernandez JM, Mateos V. Cystic bulbar hemangio blastoma. Rev Neurol 2008;47:134-6.
Arie F, Peter P, Rimas VL, Rupa C, John MC. CNS hemangio blastomatosis in a patient without von Hippel–Lindau disease. CNS Oncol 2017;6:101-5.
Shukla V, Tripathi RD, editors. Charak Samhita of Agnivesh, Chikitsa Sthana; Vatavyadhi Chikitsa. Ch. 28., Ver. 3-249. Delhi: Chaukhamba Sanskrit Pratishthan; 2011. p. 686-724.
Shukla V, Tripathi RD, editors. Charak Samhita of Agnivesh, Chikitsa Sthana; Vatavyadhi Chikitsa. Ch. 28., Ver. 59. Delhi: Chaukhamba Sanskrit Pratishthan; 2011. p. 699.
Shastri AD, editor. Sushruta Samhita of Sushruta, Nidana Sthana; Vatavyadhi Nidana. Ch. 1., Ver. 8. Varanasi: Chaukhamba Sanskrit Sansthan; 2014. p. 295.
Shukla V, Tripathi RD, editors. Charak Samhita of Agnivesh, Chikitsa Sthana; Vatavyadhi Chikitsa. Ch. 28., Ver. 199. Delhi: Chaukhamba Sanskrit Pratishthan; 2011. p. 717.
Shukla V, Tripathi RD, editors. Charak Samhita of Agnivesh, Chikitsa Sthana; Vatavyadhi Chikitsa. Ch. 28., Ver. 204-205. Delhi: Chaukhamba Sanskrit Pratishthan; 2011. p. 718.
Vasant V, Sapra UK. Clinical Diagnosis in Ayurveda. 1st
ed. Ilkal, Karnataka: Atreya Ayurveda Publication; 2011. p. 11.
Vasant V, Sapra UK. Clinical diagnosis in Ayurveda: Concept, current practice and prospects. J Ayurveda Holist Med 2013;1:1-7.
Mehta SP, Joshi SR, Mehta NP. Practical Medicine for Students and Practitioners. 20th
ed. Mumbai: The National Book Depot; 2013. p. 275.
Gopal K. Rasatantrasara va Sidhaprayoga Sangrah. Part 1., 16th
ed. Rajasthan: Krishan Gopal Ayurveda Bhavan; 2003. p. 532.
Tomar P, Dey YN, Sharma D, Wanjari MM, Gaidhani S, Jadhav A. Cytotoxic and antiproliferative activity of Kanchnara Guggulu, an ayurvedic formulation. J Integr Med 2018;16:411-7.
Gharate MK, Kasture V. Evaluation of anti-inflammatory, analgesic, antipyretic and antinuclear activity of Punarnavasava: An ayurvedic formulation of Boerhavia diffusa
. Orient Pharm Exp Med 2013;13:121-6.
[Table 1], [Table 2]