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

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 184
Scheme XIII-2: Cerebrospinal Fluid Hypertension Syndrome causing chronic Optic Nerve’s
borders edema, and spreading it through retinoschisis or under the retinal pigment epithelium into the
posterior pole and macula. The consequences are multiple macular, retinal and under-retinal degeneration.
Studying “patients with glaucoma without optic nerve pits,” the authors concluded: “Peripapillary
retinoschisis, (one of them extending into the macula), may represent a unique sequelae of intraocular
fluctuations in patients with uncontrolled glaucoma.” (Kahook M Y, and others).
Studying patients with macular neurosensory detachments related with Optic Nerve’s pits, the authors
found “Retinal edema and cystic degeneration, with macular neurosensory detachments, most prominent
in the retina at the level of the outer plexiform layer. A lesser degree of edema was present in the inner
retina, predominantly located between the disc and fovea. The schisis-like cavity or swollen retina
communicated with the optic disc in all eyes, whereas none of the eyes demonstrated a direct connection
between the macular detachment and the optic pit. Fluid may enter from the optic pit into the retinal
stroma and not directly into the subretinal space.” (Rutledge B K, ad others).
“Subretinal fluid accumulations can cause decreased visual acuity in patients with papilledema. Optical
coherence tomography can demonstrate subretinal fluid and can be used to follow the course of
this important visual complication of papilledema. The subretinal fluid appeared to arise from the peripapillary
region.” (Hove V J 3rd, and others).
“A 42-year-old man with idiopathic intracranial hypertension and chronic papilledema had severe
visual loss in his left eye caused by subretinal bleeding from a peripapillary choroidal neovascular
membrane” (Sathornsumetee B, and others).