Complaints Of Difficulty Research Articles

Case report: exome sequencing identified mutations in the LRP5 and LGR4 genes in a case of osteoporosis with recurrent fractures and extraskeletal manifestations

BackgroundGenetic mutations have been reported in a number of bone disorders with or without extra-skeletal manifestations. The purpose of the present study was to investigate the genetic cause in a middle-aged woman with osteoporosis, recurrent fractures and extraskeletal manifestations.MethodsA 56-year-old Indian woman presented to the clinic with complaints of difficulty in walking, recurrent fractures, limb bending, progressive skeletal deformities, and poor overall health. At the age of 37, she had experienced severe anemia with diarrhea, significant weight loss, knuckle pigmentation, and a significant loss of scalp hair. She had received multiple blood transfusions and parenteral iron supplementation with normalization of hemoglobin. Subsequently, she had premature menopause at the age of 37. She died at the age of 61 due to liver failure. Exome sequencing followed by Sanger sequencing were undertaken to identify the potential pathogenic mutations.ResultsGenetic investigation identified likely pathogenic mutations in the LRP5 and LGR4 genes. Out of the two mutations, the heterozygous mutation (c.1199C>T) in the LRP5 gene resulted in a non-synonymous substitution of alanine with valine at the 400th position, and the second mutation (c.1403A>C) in the LGR4 gene led to a non-synonymous substitution of tyrosine with serine at the 468th residue of the protein. The minor allele frequencies of the c.1199C>T (LRP5) substitution in the 1000 genomes and IndiGenomes databases are 0.0003 and 0.001, while the c.1403A>C (LGR4) substitution has not been reported in these databases. Various in silico prediction tools suggested LGR4 mutation to be pathogenic and LRP5 mutation to be likely pathogenic.ConclusionHeterozygous mutations in the LRP5 and LGR4 genes had additive deteriorative effects on BMD, resulting in recurrent fractures and bone deformities, and extended the effect to extraskeletal sites, contributing to the poor overall health in this patient.

Frenectomy management for Ankyloglossia in a 1-Year-old patient under general anesthesia: A case report

Introduction: Ankyloglossia is defined as a congenital disorder that alters tongue mobility and function. It is listed as one of the possible reasons behind breastfeeding issues. The WHO currently recommends mothers to breastfeed exclusively up to 6 months of age, emphasizing the importance of promptly identifying any breastfeeding obstacles and determining the root cause of the problems as the primary focus. The purpose of writing this article is to describe a frenectomy as a surgical procedure that addresses ankyloglossia by excising the lingual frenulum with general anesthesia. Case History: A 1-year-old male patient presented at Dr. Saiful Anwar Regional General Hospital with complaints of difficulty in breastfeeding and consuming complementary foods, as well as prolonged pain experienced by the mother during breastfeeding. The patient had no history of systemic diseases such as heart disease or blood disorders, and there were no known allergies to food or medications. The patient was uncooperative (Frankl scale number 1). After analyzing the ankyloglossia, the choice of frenectomy with general anesthesia was chosen to treat this case. Discussion: Dental examinations and treatments for uncooperative 1-year-old children can be challenging in regular dental offices. Effective behavioral management, such as general anesthesia (GA), is required for safe and efficient treatment. GA involves a multidisciplinary team to oversee the procedure stages, allowing for one-visit treatment, reduced anxiety, and a safer, less painful dental experience. Conclusion: Frenectomy procedure under GA has been performed as an option to facilitate restorative therapy, improve nutritional intake, and quality of life.

Management of Ankyloglossia with different severity: a case series in dental surgery

Introduction: The lingual frenulum is an important oral structure that plays an important role in the act of suction, speech, and feeding. Ankyloglossia (tongue tie) is a congenital anomaly that results when lingual frenulum is too short and adhere to tip of tongue, limiting the tongue movement. This case report aimed to explain management of Ankyloglossia with different severity. Case Report: This case report reported three cases of ankyloglossia with different ages and complaints of difficulty in feeding and speech. The patients were treated for lingual frenectomy procedure under general anesthesia using one haemostats method. The haemostats were used to clamp the upper aspect of frenulum which might have been helpful to guide the incision close to ventral surface of tongue. Care had to be taken not to injure the submandibular ducts when making incision at lower part of tongue. The result after 1 week of surgery: the wound was completely healed. Conclusion: Ankyloglossia will impair the function of suction, speech and feeding that affecting a considerable number of infants and children. It is important that accurate information and guidance are given to parents with regard to the indications and potential benefit of tongue tie revision. These case series offer guidelines which can be used by general and pediatric dentist for examination, diagnosis and treatment of ankyloglossia in different severity.KeywordAnkyloglossia, congenital, lingual frenulum

Solitary Isolated Oropharyngeal Neurofibroma Presenting With Dysphagia in the Setting of Von Recklinghausen's Disease.

A 24-year-old man with von Recklinghausen's disease presented with complaints of difficulty in swallowing for 6 months and change of voice for 3 months. He also had recent-onset difficulty in breathing. Telelaryngoscopy and subsequent contrast-enhanced computed tomography scan revealed a well-defined, smooth submucosal mass in the oropharynx (attached to the posterior pharyngeal wall, superior to the level of left aryepiglottic fold), obscuring the ipsilateral pyriform fossa, and nearly blocking the pharyngeal lumen. The mass was removed with endoscopic coblation-assisted laryngeal surgery, and subsequent histopathology revealed it to be neurofibroma. Neurofibromas are rare neoplasms to be encountered in the oropharynx. However, in the setting of von Recklinghausen's disease (neurofibromatosis type 1), one or more well-demarcated, submucosal nodular lesions in the upper aerodigestive tract may be considered as neurofibromas, and workup and treatment should be directed accordingly based on this clinical presumption. Endoscopic coblation during laryngeal surgery can effectively be used as a surgical tool to excise such lesions. It provides a relatively bloodless field compared to the conventional cold steel excision, and reduces the risk of complications at surgery and during the follow-up period. This clinical record illustrates the presentation and management of a solitary, isolated oropharyngeal neurofibroma in a man suffering from von Recklinghausen's disease. It further emphasizes the role of endoscopic coblation-assisted laryngeal surgery in this setup, and the need to maintain a low threshold of suspicion in having a provisional clinical diagnosis of such lesions.

Multiple congenital anomalies in a late-preterm neonate: A case of possible carbimazole embryopathy

ABSTRACT The use of carbimazole in the treatment of hyperthyroidism in pregnant women is associated with several congenital anomalies, especially when used during early pregnancy. Some of the reported congenital anomalies include aplasia cutis congenita, choana/esophageal atresia, facial dysmorphism, and cardiovascular/gastrointestinal anomalies. We report the case of a 17-day-old late-preterm neonate who presented with complaints of difficulty in breathing, darkening of the lips/extremities, and abnormal facies observed since birth. The mother had been on tablet carbimazole 20 mg daily for the treatment of hyperthyroidism until the fifth week of gestation from the time she was confirmed to be pregnant. Physical examination and further evaluations revealed multiple congenital anomalies, including facial dysmorphism, bilateral arthrogryposis of the lower limbs, micropenis, complex congenital heart disease, and intestinal obstruction. This case report, therefore, highlights the need to avoid the use of imidazole derivatives such as carbimazole during the pre-conception period as well as in the first trimester of pregnancy.

Skin Grafting in Post burn contractures of Groin and perineum in patients

Background: Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Material and Methods: This is prospective and descriptive study conducted in the Department of Plastic Surgery at Tertiary Care Teaching Hospital over a period of 1 Year. First dressing was seen on third or fourth postoperative day and percentage of graft take/loss was noted. Complications, if any, were recorded. Indwelling urinary catheter drainage was instituted for 3 to 4 days postoperatively. Once the graft stabilized, patients were discharged and advised to wear compression garments. Results: In our study, 77.1% of the patients, post burn contractures of the groin and perineum were because of Open chulla. Other less common causes were hot water (14.3%) and flame burn (8.6%). Majority of the patients were brought with complaints of difficulty in squatting (80.0%) followed by limitation of movements of hip joints (71.4%) and (44.3%) impairment of walking. In our series of 70 patients two types of operative procedures were performed: (1) release of contracture with split thickness skin grafting; (2) release of contracture and closure by multiple Zplasties. Moreover, 30 (42.9%) patients having bilateral groin contractures underwent release of contracture with split thickness skin grafting. 29 (41.4%) patients underwent release of unilateral groin contracture with split thickness skin grafting and 4 (5.7%) patients underwent release of unilateral groin contracture and closure by multiple Zplasties.Conclusion: To conclude, recuperation from perineal burns, both in acute period and chronic phase in case contracture occurs, is a difficult challenge physically and mentally. The agony that a burn patientendures during treatment is evident even to an onlooker.

Pneumomediastinum as a primary manifestation of COVID-19: A case report

Introduction: Pneumomediastinum is a rare complication that occurs in patients with Pneumonia caused by COVID-19 and is more frequent in patients with ARDS that may or may not be related to the use of invasive mechanical ventilation. Pneumomediastinum is an indicator of clinical deterioration with potentially threatening consequences for the patient. Method: We described a case report of a 23-year-old man with Pneumomediastinum, infected with COVID-19 in conditions of respiratory failure due to interstitial pneumonia. Case presentation: A 23-year-old man, who had no pre-existing health conditions presented to the Infectious Diseases service with complaints of difficulty in breathing, dry cough, chest pain, muscle pain, joint pain, loss of taste, sore throat, pronounced body weakness, diarrhea. Symptoms started 11 days ago. On admission the patient refers that he doesn’t suffer from any other disease. The patient was not vaccinated against COVID-19. At the time of admission to the hospital, the objective examination revealed cervical subcutaneous emphysema and harsh respiration in both lungs. The nasopharyngeal swab test (RT-PCR) for Covid-19 was positive from the Institute of Public Health. The CT scan of the chest confirmed the presence of pneumomediastinum major, subcutaneous emphysema and bilateral ground glass opacities. Conclusion: Pneumomediastinum is a rare complication of pneumonia caused by Covid-19 in which the etiopathogenesis consists of severe pulmonary involvement that may or may not be affected using invasive mechanical ventilation. Timely diagnosis of pneumomediastinum in patients with Covid-19 would prevent the occurrence of life-threatening complications. Keywords: Covid-19, pneumomediastinum, ARDS, Macklin effect, vaccine.

Significance of Mrudu Virechan (laxatives) and Specific Medicines in the Management of Bronchial Asthma: A Case Report

Difficulty in breathing, shortness of breath, fever, and cough are common respiratory complaints seen in bronchial asthma. It is the most prevalent chronic health issue affecting individuals in the paediatric age group. Tamaka Shwasa is one among the five varieties of Shwasa Roga in Ayurveda. The purpose of present case study was to examine how an Ayurvedic treatment plan might be applied to cases of bronchial asthma. Hereby, the authors present a case report of a 10-year-old female child who was brought to the clinic by her parents, presenting with complaints of difficulty in breathing, shortness of breath, and occasional sneezing. Based on the history taken and clinical examination, she was diagnosed as a case of Tamaka Shwasa, having suffered from it since, the age of five. The child was treated according to the treatment protocol cited in classic text books of Ayurveda that is Virechana and other medications, for a period of two months, divided into two sittings. After two months, there was a notable decline in clinical features, such as cough, breathlessness, and cold, as reported by her mother. Additionally, there was a decrease in the eosinophil count. The present case study demonstrates the role of Ayurveda in the management of bronchial asthma.

Management of Macular Dystrophy Through Ayurveda - A Case Study

Macular dystrophies are a group of inherited disorders with progressive macular atrophy. They are characterised by bilateral symmetrical macular abnormalities associated with progressive visual loss. One in 1490 people worldwide are affected by this uncommon genetic condition. A 16-year-old female student presented with a complaint of difficulty in seeing far objects since 2016. A clinical diagnosis of macular dystrophy was made. Treatment protocol included Virechana Basti Karma and Kriyakalpas such as Seka Netrabhynga Pindi SSPS Shashtika Shali Pinda Sweda and Tarpana with eye exercises as well as combinations of internal pharmaceuticals including Mahatriphala Ghrita Sapthamrita Loha Cap. Netraraksha and Tab. AOIM-Z. After three follow- up visits the patient could appreciate subjective improvement in the vision. This case highlights the importance of managing macular dystrophy through Ayurveda.

Papillary carcinoma arising in a throglosal cyst with no associated thyroid lesion: An unusual case

ABSTRACT Introduction: Thyroglossal cyst is the most common development anomaly of thyroid gland as well as it represents the most common congenital neck mass. Thyroglossal duct associated malignancy is very rare, and majority is papillary carcinoma. Case: A 21-year-old female presented with a painless midline neck swelling. There are no complaints of difficulty in swallowing, breathing, or voice changes. Ultrasonography revealed a multiloculated cystic lesion in midline neck region. The patient underwent Sistrunk procedure. Histopathology revealed foci of papillary carcinoma in association with thyroglossal duct cyst. Discussion: Thyroglossal duct cyst remains the most common anomaly of thyroid development. It is also the most common congenital neck swelling. The malignancy associated with thyroglossal duct cyst is very rare. Suspicion of malignancy may arise when the cyst appears irregular, hard, and fixed. Conclusion: In our case, the presence of papillary structures in thyroglossal duct support the diagnosis of papillary carcinoma arising from thyroglossal duct rather than a secondary tumor or metastasis from other organs such as thyroid gland. A diagnosis of papillary carcinoma in a thyroglossal duct cyst requires comprehensive surgical management and vigilant follow-up.

Evaluation of Sleep Quality in Patients with Tinnitus

Aim: Tinnitus is the perception of sound in the absence of auditory stimuli. Tinnitus may affect daily life activities and cause complaints of difficulty in concentration, emotional distress and sleep disturbance. The aim of this study was to evaluate the relationship between tinnitus and sleep quality. Materials and Methods: Eighty-one patients (42 females, 39 males) with subjective tinnitus lasting more than 6 months in the last 6 months were included. Tinnitus handicap index (THI), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires were used. Results: There was a moderate statistically significant positive correlation between THI and both PSQI (r=0.411; p=<0.001) and ISI (r=0.436; p=0.003). As THI increased, PSQI and ISI increased. Conclusion: Evaluating sleep quality is important in treatment planning to control tinnitus and improve the quality of life in tinnitus patients. Keywords: Tinnitus; Sleep Quality; Questionnaire

Fuctional balancing in complete dentures- A case report revisiting the paterson’s technique

: A good occlusion is the key to the comfort and longevity of a prosthesis. : This case report presents a 63 year old male patient who reported with the complaint of difficulty in chewing since past 3 months.: On examination, the patient presented with completely edentulous upper and lower arch. A detailed case history was recorded followed by, primary and secondary impressions. The maxillo-mandibular relation was recorded conventionally on wax occlusal rims. A trough was then made in the wax and filled with a mixture of dental plaster and carborundum. The mix was kept 2mm above the plane. The rims were inserted and the patient was instructed to perform lateral and protrusive movements resulting in the incorporation of the compensating curves. The recorded plaster index served as a guide for the teeth arrangement. The denture was processed and delivered with very minimal need for post insertion corrections.: According to Paterson (1923), an articulator with lateral movements is not necessary to establish a balanced occlusion when using the functional technique. The teeth arrangement is entirely dependent on the established curves for obtaining balance.: Various techniques are cited throughout the literature to provide a successful prosthesis. With all the advances in the digital era, denture fabrication is not an automated procedure. It is pertinent that the clinicians master the fundamentals of prosthesis fabrication, without which any amount of technology and/or persistence might be in vain.

Enigma of Esophageal - Respiratory Fistula in Advanced Esophageal Cancer

Background: The incidence of malignant esophageal-respiratory fistulas in esophageal cancer patients is not so frequent. The fistula development in esophageal cancer may be due to advanced disease or a radiotherapy-related complication. Rarely, a pulmonary abscess may develop, which is the most dreadful complication resulting in dismal outcomes. Here, we reported 2-cases of esophageal-respiratory fistula; one with esophageal bronchial fistula and the other with esophageal pleural fistula.
 Case reports: A 46-year-aged man presented with complaints of difficulty in swallowing for 4 months. CECT chest showed an esophageal growth of 8.5 cm in the lower esophagus. The patient received palliative radiotherapy followed by palliative chemotherapy and showed some improvement in dysphagia. Nine months after the start of treatment, the patient’s dysphagia began to worsen, and he was put on oral metronomic chemotherapy. After 1-year of metronomic chemotherapy, the patient developed cough and chest pain and was diagnosed with an esophageal-pleural fistula with chest wall collection and pleural effusion. The patient was managed conservatively and later lost to follow-up. Another 65-year-old patient presented with dysphagia for 3-months. CECT chest showed an esophageal growth of 5.5 cm in the middle esophagus. The patient received palliative radiotherapy, after which the dysphagia improved. In 3rd month of follow up patient’s dysphagia worsened; barium swallow showed esophageal-bronchial fistula. The patient was managed symptomatically and later lost to follow-up.
 Conclusions: Fistula formation and subsequent abscess results in a poor prognosis. With advancing disease and compromised general condition of the patient, palliation of symptoms is a significant challenge. Treatment becomes difficult due to the rare occurrence of fistulas and the non-standardization of the treatment protocol. Invasive treatment includes esophageal-pulmonary resection, endoscopic placement of self-expandable covered stents, drainage of empyema and obliteration of empyema cavity, esophageal diversion, and non-invasive treatment includes best supportive care. However, even with appropriate treatment, the outcome is dismal.

A Case of Ochronosis with Spontaneous Rupture of Bilateral Achilles Tendon

A 39-year-old male presented to the orthopaedic OPD with complaints of difficulty in walking since 3 months associated with pain over bilateral heel region. The pain was also associated with intermittent popping sound from bilateral ankle joints. Local examination revealed bilateral loss of Achilles tendon contour along with increased range of dorsiflexion and tenderness. Thompson squeeze test and O’Brien needle test were positive indicating rupture of Achilles tendon.

A rare case of juvenile primary lateral sclerosis

Primary lateral sclerosis (PLS) is a rare, neurodegenerative disorder, which affects the upper motor neurons (UMN), predominantly the large pyramidal cells of corticospinal and corticobulbar tracts, common during fourth to fifth decade of life. Juvenile PLS is an autosomal recessive form with ALS2 gene mutation on 2q33.2 chromosome affecting infants and children. A 6-year-old girl presented with complaints of difficulty in walking and climbing stairs noticed by parents in the last 2 months and frequent falls associated with stiffness of lower limbs for 15 days with no other significant history. Central nervous system (CNS) examination was normal except for spasticity in bilateral lower with exaggerated lower limb reflexes with spastic gait. Baseline laboratory investigations were normal. Magnetic resonance imaging (MRI) brain and spine showed symmetrical signal abnormality along corticospinal tracts bilaterally. Diagnosis of primary lateral sclerosis was made after ruling out possible causes.

Charcot Spine Arthropathy (CSA)- a Rare Case Report

Charcot Spine Arthropathy (CSA) is a form of degenerative disease affecting vertebra of lumbar and thoraco-lumbar region. It is commonly seen after injury to the spinal cord or in patients with traumatic paraplegia. It was first described by Kronig in 1884. Case Report- A 35year old male patient presented to our outpatient clinic with complaint of difficulty in changing his position while sitting, lying down, and sitting on a wheel chair. In 2014, he had sustained injury to his spinal cord with bowel and bladder involvement with ASIA-A grade neurology for which long segment fixation was performed from D7-D10 level and the patient was wheel chair bound after surgery. In the present case scenario, the patient was managed conservatively with bed rest, immobilization and medications for pain relief as stated in the existing literature. Conclusion- CSA is a disease of surgical origin commonly seen in patients with spinal cord injury in the past. Although surgery in the form of circumferential arthrodesis is the treatment of choice in most of cases, it is reserved for cases with instability, as it is associated with complications like infections and hardware failure.

URETHRAL INJURY IN REGIONAL HOSPITAL IN THE BPJS ERA: A CASE REPORT

ABSTRACT
 Objective: To present a case of urethral injury treated in a male adult. Case(s) Presentation: A 48 year old Asian male patient previously involved in a motor vehicle accident presented to the hospital with a chief complaint of pain and bleeding from the genitalia. On examination, it is revealed bleeding from the urethral meatus, pain in touch, palpable bladder, high riding prostate, and a butterfly-shaped bruising on the perineum. X-ray examination demonstrated soft tissue mass in the right scrotal region. The patient is diagnosed with urethral rupture with urinary retention and then underwent ultrasonography-guided cystostomy and perineal hematoma evacuation. The patient is followed-up 1 month later with a complaint of difficulty in voiding and erectile dysfunction. The patient is then diagnosed with urethral stricture and underwent direct vision urethrotomy. Discussion: Urethral injury is a rare type of injury of genitourinary trauma that may cause long term morbidity such as strictures, incontinence, impotence, and infertility. Urethral injury can be classified into posterior urethral injury which is associated with pelvic fracture and anterior urethral injury which is associated with blunt trauma. The gold standard of radiographic examination in urethral injury is dynamic retrograde urethrography. Prompt diagnosis, staging, and selecting intervention must be done for minimalizing complications. Sequelae may also develop which also affects quality of life. The usage of universal health coverage such as BPJS in In Indonesia can increase the accessibility of medical treatment. Conclusion: Urethral injury is a rare injury that requires prompt and careful management to minimize complications and increase the patient’s quality of life.
 Keywords: Urethral Injury, urethrotomy, urethral stricture.

Subcutaneous basidiobolomycosis: An unusual fungus in immuno-competent children, vindicating longer duration of anti-fungal treatment

Subcutaneous Basidiobolomycosis is a rare fungal infection caused by environmental saprophyte Basidiobolus ranarum. The disease is seen among immunocompetent individuals of age 18 months to 80 years, being more common in children. We report a case of Subcutaneous Basidiobolomycosis in a 10-year-old immunocompetent male child from Ahmednagar, Maharashtra who presented with complaints of right gluteal non tender, diffuse swelling, which was gradually progressive involving inner and back of thigh. The overlying skin was hyperpigmented with scaling at places. It was associated with complaints of difficulty in walking and voiding of urine. Patient was prescribed multiple medicines with no records available. All primary investigations were done along with a deep incisional biopsy for histopathology. MRI was suggestive of? lymphangioma? vascular malformation. Histopathology revealed panniculitis with dense collections of eosinophils. Few broad, aseptate fungal hyphae were seen camouflaged within the inflammatory infiltrate, surrounded by Splendore-Hoeppli phenomenon. The patient was treated with oral fluconazole for a period of one year with complete resolution of the symptoms. After one year of follow-up, the patient is clinically well. Clinically, this lesion presented as induration of skin and subcutaneous tissue thus mimicking a soft tissue sarcoma. However, histopathological examination clinched the diagnosis. Fungal infections are common in immuno-suppressed patients, and extremely uncommon in children. Since this is an exceptional rare fungal infection seen in immuno-competent children and young adults, it is often disregarded as a differential diagnosis.

AYURVEDIC MANAGEMENT OF MULTIPLE SCLEROSIS- A CASE STUDY

Multiple sclerosis (MS) is one of the autoimmune disorders where the immune system attacks the covering of nerve fibers (myelin sheath) and causes communication problems between the brain and the rest of the body. It is characterized by symptoms such as difficulty in walking, weakness of limbs, blurred vision, urinary and bladder incontinence. A 68-year-old female known case of Multiple Sclerosis from the United Kingdom approached the Panchakarma Outpatient department with complaints of difficulty in walking without assistance, weakness in the bilateral lower limb, disturbed sleep, urinary incontinence, bowel urgency and disturbed sleep for 29 years and was diagnosed as Pranavrita vyana vata and Majja Dhatu kshaya. Initially, the Avarana hara line of treatment was adopted, followed by Samanya vata vyadhi chikista. The outcome of the treatment was assessed by the Modified ashworth scale, Berg balance Scale, Barthel index of daily activities, Lower motor extremity index, MS walking scale and Sleep Quality Scale. Good improvement was observed in terms of walking, sleep, reduction in pain, weakness and heaviness. Ayurveda Panchakarma therapies, along with Shamanoushadhi, have provided promising results in the present case.

A case study on the Ayurvedic management of Sixth (Abducens) Nerve Palsy

Abducens nerve (sixth cranial nerve) supplies the lateral rectus muscle of the eye. Abduction of the eye is carried out by the contraction of the lateral rectus muscle. The sixth cranial nerve palsy is a nonspecific sign of increased intracranial pressure and typically resolves following normalization of the intracranial pressure. Most of the patients with sixth nerve palsies experience diplopia. In the conventional practice, this phase is best managed by patching the paretic eye or by frosting a spectacle lens. As per Ayurveda, diplopia is told under Dwitiya Patalgata Timira by Acharya Vagbhata, whereas Acharya Sushruta has included diplopia under Tritiya Patalgata Timira. Case: A 32 year old female patient came to the Shalakya Tantra OPD of SJIIM, Bengaluru with complaints of difficulty in turning right eye away from nose i.e., crossing of eye inward towards nose; headache was constant over right frontal and retroorbital area since 3days with no history of diabetes mellitus and hypertension. She approached to an ophthalmologist and was advised for treatment modalities like occlusion of the eye or using prisms until the diplopia subsides, botulinum toxin injections. As the patient was uncomfortable for undertaking conventional method of treatment hence came to an Ayurvedic hospital to undergo treatment. Conclusion: Isolated 6th nerve palsy and its Ayurvedic management has provided satisfactory results and provided relief from the symptoms.