Fluids Hypertension Syndromes: Migraines, Headaches, Normal ...

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 131
Normal Tension Glaucoma and sleeping with TV set open: We had a 20-year-old white miss, 1.57
meters (5 feet and 2 inches) tall, 47 Kilograms (103 pounds), arterial pressure 11/7, who came with
diagnosed glaucoma since 12-year-old, visual fields with scotomas and Optic Nerve’s stereo-photos
showing increased cup-disk ratios. She used daily Prostaglandin eye drops and Haloperidol by mouth
for “nervousness”. She presented Optic Nerve’s disk cups of 0.7/3/3/0.25 right eye and 0.5/3/3/0,25 left
eye (cup-disk diameter/cup depth/lamina cribosa’s pores visibility/ borders edema). She complained of
eyes and head’s migraines, photophobia, tearfulness, and rhinitis. She drank guaraná and coffee daily,
and beer at weekends. She presented with astigmatism in both eyes, but her eyeglasses were wrong
with negative cylinders, and a careful refraction show us that she needed positive cylinders.
We prescribed her do not drink beer or soft drinks, the correct eyeglasses, to maintain the eye drops
and stop the Haloperidol. She returned after 6 months, with the same complaints. She had stopped the
caffeine and beer drink and the Haloperidol, was correctly using the eye drops, her intraocular pressure
were 10 and 14 mmHg, and the ophthalmoscopy shows that her right eyecup increased to
0.8/3/3/0. She was not using her eyeglasses, and after asking her activities we discovered that she daily
works 6 hours with computer, she frequents 4 hours of school, she watches 2 hours of TV, she ate a
brief dinner and watches more 2 hours of TV until fall asleep with the TV set open. She probably puts
one arm over her eyes when sleeping, but she is not sure about it. We prescribed her to use her eyeglasses,
to stop the TV excessive hours and to shut off the TV set before sleeping, but without much
chance to be obeyed.
XI- 22) – Irregular sleep:
Sleeping too much, sleeping less than the necessary and interrupted sleep caused intraocular pressures
raises, Migraines and Normal (Peak) Tension Glaucomas. We had some patients with these etiologies,
but we did not make statistics on them.
XI- 23) – Lumbar (dural) puncture (spinal tap) and Spontaneous intracranial hypotension:
The lumbar (dural) puncture (spinal tap) suddenly lowers the Cerebrospinal fluid pressure. It immediately
causes relative excess of intraocular pressure and respective Optic Nerve’s disk squeeze. The consequences
are migraines and headaches from the Ocular Hypertension Syndrome, and neural aches and
brain disturbs caused by the sagging of the brain inside the skull, mainly when the patient stands up.
This endures until the Dura mater perforation caused by the hypodermic needle closes, which occurs
in few days, but it can last many years (Baerentzen F O, and Mathiesen O). This occlusion can be
achieved by a blood patch out-side the perforation. The cerebrospinal fluid’s hypotension can cause
cranial nerve’s damage, mainly in the ocular nerves, which last many months to recover, if it does.
This also can be spontaneous: “Spontaneous intracranial hypotension is due to cerebrospinal fluid
leakage, usually in the area of the cervical or upper thoracic spine, often without a clear etiology.”
(Frank L R and others).
The intracranial hypotension causes orthostatic headache, until it is cured, usually after epidural
blood patches. Frequently it is misdiagnosed.
We did not have patients with these two Migraines etiologies.
XI- 24) - Ocular compression during ophthalmological surgeries and exams: We had patients
whose Optic Nerve’s cups worsened after hospitalization, when they were submitted to ocular surgeries
or treatments. Some ocular surgeries (Cataract, Refractive, Vitrectomy, and others) cause high rises of
the intraocular pressure, during some minutes. This ocular hypertension causes Low (Peak) Tension
Glaucoma.
“The results of this study indicate a significant statistical variation on the values (of the retinal fibers
layer) out of GDx Scanning System after cataract surgery.” (Translated from Portuguese). (Prata Jr, J A,
and others).
“The ophthalmological physicians must be conscious that the refractive surgery introduced new kinds
of glaucoma and the re-establishing of old ones.” (Translated from Portuguese). (Guttman C).
“The average intraocular pressure under the Hansatome suction ring (for refractive surgery) was 89
mmHg, while on the ACS was 88 mmHg.”(Translated from Portuguese). (Nakano K and others).