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

Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 206
Brain infarct-like lesions: “In total, 39 posterior circulation infarct-like lesions represented the majority
(65%) of all 60 identified brain infarct-like lesions in the study sample (n = 435 subjects with and
without migraine). Most lesions (n = 33) were located in the cerebellum, often multiple. The majority
(88%) of infratentorial infarct-like lesions had a vascular border zone location in the cerebellum.” “Prevalence
of these border zone lesions differed between controls (0.7%), cases with migraine without
aura (2.2%) and cases with migraine with aura (7.5%).” “The results suggest that a combination of
(possibly migraine attack-related) hypoperfusion and embolism is the likeliest mechanism for posterior
circulation infarction in migraine.” (Kruit M C, and others).
“The risk of posterior circulation strokes, especially cerebellar, is increased in migraineurs with aura.
Female migraineurs, with or without aura, have an increased risk of deep white matter brain lesions.”
(Sahai-Srivastava S, and Cowan R).
“These 14 studies suggest that the risk of stroke is increased in people with migraine (relative risk
2.16). This increase in risk was consistent in people who had migraine with aura (relative risk 2.88) and
migraine without aura (relative risk 1.56), as well as in those taking oral contraceptives (relative risk
8.72).” (Etminan M, and others).
“Both ischaemic stroke and migraine with aura might be consequences of many underlying vascular
disorders.” (Bousser MG and Welch KM).
Most auras are consequent to the ischemia caused by the vasoconstriction. This ischemia added with
the ischemia caused by the Cerebrospinal fluid hypertension, turns the patient with migraines with aura
prone to an ischemic stroke.
“Migraine with aura in midlife was associated with late-life prevalence of cerebellar infarct-like lesions
on MRI. This association was statistically significant only for women.” (Scher A I, and others).
The estrogens cause liquids retention in the women body that also rises the Cerebrospinal fluid pressure,
which causes brain ischemia. This is one more risk factor, which added with others, can cause the
ischemic brain stroke.
We conclude that to prevent the risk of a brain stroke, any women with her physiologic estrogens,
and specially those taking oral contraceptives with estrogen, must stop the other preventable
risk factors: caffeine, wine, beer, excessive water drank, Ergots and Triptans that are vasoconstrictors.
Otherwise, these risk factors together with the contraceptives can become etiologies and
cause a brain stroke.
Cerebrospinal Fluid Hypertension Syndrome: the first sign was a Central Retinal Vein Thrombosis
or a Stroke. We had a strong “Brazilian white”, with Indian, Black and White ancestors, 38year-old,
electrician. He was 1.70 meters (five feet and 7 inches) tall, and 82 kilograms (181 pounds)
of weight. He was complaining only about a small sty on his left upper eyelid since 3 days before, and
no other symptom. He was a drinker of daily Guaraná, water around 2,000 milliliters (4 pints) and at
weekends some beer, without hangover. This was nothing to alarm.
His mother died with only 37 year-old, from a cerebrovascular accident, a stroke. At that time he was
6-year-old, and remembered that she drank “much coffee”. On the examination, we found no need for
eyeglasses, intraocular pressure of 20 mmHg in both eyes, which is moderately high, but no headaches
nor migraines. He presented deep physiologic anterior chambers. On direct ophthalmoscopy, his Optic
Nerve’s disks show 0.5/3/1/0.5 and 0.2/1/0/0.75 right and left eyes (cup diameter/ cup depth/ lamina
cribosa’s pores visibility/ borders edema). This is a little damage in his right eye from the raised ocular
hypertension, but it is still without glaucoma, and present evident borders edema on both disks from
the raised Cerebrospinal Fluid pressure, bigger at the left Optic Nerve. The visual acuity was 20/20
(physiologic) on both eyes, and no need of eyeglasses.
We medicated his sty, and warned him to stop all caffeine and beer. To a Brazilian man at this age
this is a difficult task.