Ayurveda Management of Chronic Post-stroke Hemiparesis Associated with Cognitive Impairment and Urinary Incontinence: A Case Report

Background: Stroke is a leading cause of long-term disability; it can result in persistent disability in the form of hemiparesis, cognitive impairment and bladder dysfunction.The condition can be linked to Pakshaghata in conjunction with Smriti Bhramsha and Mutravaha Strotodushti (particularly Atipravritti).Case report: A 67-year-old female presenting to the outpatient department (OPD) of Kayachikitsa with complaints of weakness of her left upper and lower limb, progressive cognitive decline mainly involving recent memory over last 1.5 years and urinary incontinence (UI).Clinical evaluation found muscle power to be 3/5 and deep tendon reflexes were exaggerated.Cognitive assessment reveals impaired recent memory, delayed response time, and decreased attention.Brain MRI (pre and post contrast) scan revealed old parenchymal hemorrhage, chronic lacunar infarcts, generalized cerebral atrophy and chronic white matter ischemic changes consistent with chronic post-stroke sequelae.Therapeutic intervention: Ayurvedic management for 20 days included individualized panchakarma procedures viz.Shirodhara, Nasya, Basti alongside internal medications targeting Vata Shamana, Majja Dhatu Poshana, improvement of cognitive function (Smriti Vardhana) and bladder control.Results: Following this therapy she exhibited improvement in muscle power (from 3/5 to 5/5), significant reduction in International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score (from 13 to 4).There was also improvement in areas of memory, attention, and response time.Conclusion: This case suggests a potential role for individualized Ayurvedic therapy towards improving chronic post-stroke sequelae, although further well-designed clinical study would be needed to confirm these results.