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

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 168
XII z) Increased pressures of the veins: Intra-cranial, Cavernous Sinus, Superior Ophthalmic, Inferior
Ophthalmic, and Episcleral veins, causing Cerebrospinal Fluid Hypertension and Ocular
Hypertension. Valsalva maneuver.
There are pathologies which raise the intra-cranial venous pressure, sequentially increasing the venous
Cavernous Sinus pressure, and sequentially increasing the superior and inferior Ophthalmic Veins
pressures, which drain the blood from the eye, increasing intraocular exudation and hemorrhages, increasing
the Aqueous Humor secretion and causing the glaucoma.
The elevated superior and inferior Ophthalmic venous pressures also increase the Episcleral venous
pressures, which drain the Aqueous Humor from the eye, and consequently they also raise the intraocular
pressure and causes the glaucoma.
“Associated with an increased episcleral venous pressure is a rise in intraocular pressure which, if of
sufficient magnitude and duration, may cause cupping of the optic nerve and visual field loss”. (Bigger
JF).
A strong etiology to this pathophysiology is the Valsalva Maneuver:
Valsalva maneuver, for evacuation, for weight lifting, etc. It causes many pathologies, with at least
five pathophysiologies that affect the fluids' pressures, and causes the Normal (Peak) Tension Glaucoma.
“Power athletes routinely utilize the Valsalva maneuver during weightlifting. There are reports of
stroke, cerebral hemorrhage, subarachnoid hemorrhage, conjunctival, foveal and retinal hemorrhage,
retinal detachment, hiatal hernia and pneumothorax associated with weightlifting. These events are
thought to occur secondary to the extreme pressure elevations that occur in the intra-abdominal, intra-thoracic,
intra-cranial, intra-ocular and vascular compartments. All 11 subjects resting intra-ocular
pressure were within normal ranges (mean 13 +/- 2.8 mmHg). Intra-ocular pressures were significantly
elevated in each subject during maximal contraction (mean 28 +/- 9.3 mmHg). One subject's intra-ocular
pressure reached 46 mmHg during maximal contraction.” (Dickerman R D, and others).
1. The first ocular effect of the Valsalva maneuver is a sudden rise of the cranial venous pressure,
which raises the Central Retinal Vein pressure, which together with low or physiologic intraocular
pressure, can cause hemorrhages inside the eye, known as Valsalva's Retinopathy.
“The clinical calling card of the Valsalva's hemorrhage is its well-encased appearance between the
retina and the posterior hyaloid face of the vitreous humor.” (Valsalva’s retinopathy).
2. The second ocular effect of the Valsalva maneuver is the rise of the intraocular pressure, consequent
to the raise the superior and inferior Ophthalmic Veins’ pressures, causing strong migraines
and glaucoma.
“Significant elevation of the intraocular pressure, narrowing of the anterior chamber angle recess,
thickening of the ciliary body, and increase in the iris thickness is seen during the Valsalva maneuver.
The Valsalva maneuver (standardized to a pressure of 40 mmHg for 15 seconds) may lead to angle
closure in eyes anatomically predisposed to primary angle closure glaucoma.” (Dada T, and others).
This sudden rise of intraocular pressure can be felt as the cluster headache: “In the episodic cluster
headache group, during symptomatic periods, between attacks, Valsalva manoeuvre elicited an asymmetric
increase in intraocular pressure with significantly higher values on the symptomatic side, whereas
no asymmetric increments in intraocular pressures were found during asymptomatic periods. The increment
in intraocular pressure took place within a few seconds, as in spontaneous episodic cluster
headache attacks.” (Barriga F J, and others).
On weight lifting, “mean intraocular pressure during exercise in mode I (the breath was held during
the last repetition) increased by 4.3 ± 4.2 mmHg. In mode II (subjects exhaled normally during the last
repetition), mean intraocular pressure increased by 2.2 ± 3.0 mmHg. The intraocular pressure increased
in 90% of subjects in mode I and in 62% in mode II. An increase in intraocular pressure greater than 5.0
mmHg was observed in 9 subjects (30%) in mode I and in 6 (21%) in mode II. In 2 subjects, intraocular
pressure during exercise mode I was markedly increased (>10.0 mmHg).” (Vieira G M, and others).