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

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 182
In all patients, we look for minimal edemas of the disk margin of Optic Nerve, whose aspect is very
similar to the normal hyperopic patients without Migraine. They are visible:
- with a direct ophthalmoscope with red-free light,
- in as entirely dark ambient,
- by a physician experienced with direct ophthalmoscopic examination, and
- careful search for the minimal Optic Nerve's borders edemas.
From our patients, 782 presented some rise or edema (0.25 Diopters or bigger) at one or both Optic
Nerve’s disk margins.
Out of these 782 patients,
- 638 (81.6%) felt Migraines or other signs or symptoms, and
- - 144 (18.4%) felt nothing.
Whether we consider only the evident edemas of 0.5 Diopters or bigger, 243 patients presented them;
out of these 243 patients:
- 210 (86.4%) felt Migraines or other signs or symptoms, and only
- 33 (13.6%) felt nothing (Table XIII-2).
Optic Nerve’s Disk borders edema from patients with and without Migraines
Edema of one or both Optic Nerves’
disks
Quantity of Patients
High of Edema With Migraines Without Migraines Total
0.25 diopter or bigger 638 (81.6%) 144 (18.4%) 782 (100%)
0.5 diopter or bigger 210 (86.4%) 33 (13.6%) 243 (100%)
Table XIII-2: Distribution of Optic Nerve’s Disk borders edema from our patients with and without
Migraines.
With the direct ophthalmoscope, we see the smaller edema degree, 0.25 diopters, as a small rise of
the Optic Nerve’s disk border or only by a gray color at part (usually inferior) of the Optic Nerve’s
Disk fibbers, masking its physiologic sharpness border. We consider this minimal edema also as
physiologic, or as “congenitally anomalous disc mimicking papilledema” (Mathews M K, Sergott R C,
Savino P J) only when there is no sign or symptom linked to it.
When there is blurring of the superior and inferior disk’s borders, we classify it as 0,5 diopters. When
there is evident blurring and rise almost complete of the disk’s borders, we classify it as 0,75 diopters.
When the disk’s borders rise needs to turn 1 diopter of the ophthalmoscope to focus it, this 1 diopter is
our classification of this edema.
When there is a raised intraocular pressure (ocular hypertension) simultaneously with the raised
cerebrospinal fluid pressure, there is no Optic Nerve’s borders edema. So, when the patient has
“Idiopathic intracranial hypertension” or Cerebrospinal Fluid Hypertension, he can present edemas on
both Optic Nerves’ disks, or only on one, or on no one, depending from the intraocular pressure at the
other side of the Optic Nerve’s Lamina cribosa:
“Three patients with benign intracranial hypertension (or Pseudotumor cerebri) had verified increased
Cerebrospinal Fluid pressure and unilateral papilledema… The diagnosis of benign intracranial hypertension
must be considered even in the absence of bilateral papilledema.” (Sher N A, and others).
We conclude that all the Optic disk border’s edemas symptomatic or with 0.5 diopters or high -
er are pathological, are signs of Cerebrospinal fluid pressure rises, with or without migraines.
Peri-vascular white sheaths around Optic Nerve’s disk vessels and Migraines: Together with the
small edemas of Optic Nerve’s disk margin, we found in some patients small visible edemas as perivascular
white sheaths around the arteries and veins exclusively at the Optic Nerve’s Disk.