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tension glaucoma with the syndrome has recently been confirmed by a group of
Chinese researchers. In a 2016 review on the risk factors for normal tension glaucoma by ophthalmologists from Asia (where this form of glaucoma is much more prevalent than in Europe or North America), Flammer syndrome has been attributed to increase the likelihood of ganglion cell damage in these patients, with disc hemorrhages as a characteristic clinical sign. Migraine attacks, a common feature of Flammer syndrome, have been described as a risk factor for glaucoma progression, in open-angle glaucoma as well as in normal tension glaucoma. Flammer syndrome may also predispose to other eye diseases such as vascular occlusion (especially retinal vein occlusion) in relatively young people or central serous retinopathy. Muscle spasms and tension are common among individuals with Flammer syndrome. Tinnitus and sometimes even acute hearing loss can occur. There is currently insufficient data available on cases where Flammer syndrome is suspected like in the sudden, unexpected deaths of young athletes. People with
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of not being underweight), avoiding periods of fasting, and avoidance of known trigger factors such as cold. Regular physical exercise is beneficial, while extreme sports might be detrimental. Nutrition should contain many antioxidants, such as those found in green tea, black filter coffee, red wine, blueberries, and fruits. Omega-3 fatty acids, especially in the form of fish, improve the regulation of blood flow, as well as ginkgo. If blood pressure is very low, salt intake should be increased. Drugs that can lead to vasoconstriction should be avoided. If blood pressure is too low, sleeping pills should be taken cautiously. Calcium antagonists like magnesium may help against the vascular dysregulation. With lifestyle interventions, attacks—particularly pronounced symptoms such as massive cold extremities, tinnitus, or migraine-like episodes—can be avoided or reduced. Stabilizing weight (i.e. not being underweight) and the avoidance of periods of fasting are important.
207:, resulting in insufficient supply of blood to the corresponding organs or parts of organs. Such spasms can occur at various locations in the human body; in this case medical terminology calls it "vasospastic syndrome". Over the years, it has been established that these spasms are usually part of a general dysregulation of blood vessels. These dysregulations can occur in spasms as well as in excessive or insufficient dilation of arteries, veins, and capillaries. The blood vessels of individuals with vasospastic syndrome respond to stimuli insufficiently. If an identifiable disease does not cause this, it is called a primary vascular dysregulation (PVD); in case of an underlying disease, it is called secondary PVD. PVD is almost always associated with other vascular and non-vascular symptoms and signs. This entire complex (PVD and accompanying symptoms) is today called Flammer syndrome.
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and red patches on the face or neck, and migraine-like pain or a feeling of pressure behind the upper eyelid. In addition, there are symptoms not directly resulting from dysregulations of the blood supply, such as a prolonged time needed to fall asleep, a reduced feeling of thirst, and high sensitivity not only to cold but also to odors, vibrations, psychological stress, or certain medications (e.g., calcium antagonists, beta blockers). Pain and muscle spasms are common.
166:, a disease with an impaired regulation of blood flow in a large number of patients. If glaucomatous damage occurs despite normal eye pressure or if glaucomatous damage is progressive despite normalized intraocular pressure, frequently Flammer syndrome is the cause. In these eyes, an elevated pressure in the retinal veins has been observed.
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The diagnosis of
Flammer syndrome is primarily based on the patient's history with its typical features as well as the findings of nail fold capillaroscopy. This test shows an excessive constriction (narrowing) in the smallest blood vessels (capillaries) of the fingers in response to being exposed to
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Flammer syndrome requires no therapy as long as the individual does not experience the symptoms or pathological sequelae occur. The treatment is based on three pillars: lifestyle interventions, diet, and medication. A healthy lifestyle should include regular sleep, weight stabilization (in the sense
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Most of the symptoms of
Flammer syndrome result from an impaired regulation of the blood supply. How these symptoms affect the patient depends on to which organs or body parts blood supply is inhibited. Typical symptoms of Flammer syndrome are cold hands or feet, low blood pressure, occasional white
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Medical treatment is necessary when normal tension glaucoma is present. In these cases, in addition to the ophthalmologic treatment of glaucoma, the patient's usually low blood pressure should be addressed. With dietary measures such as salt intake and sometimes with low-dose steroids, a drop in
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Glaucoma patients with
Flammer syndrome show some specific clinical signs like increased frequency of optic disc haemorrhages, activated retinal astrocytes, elevated retinal venous pressure, optic nerve compartmentalization, and fluctuating diffuse visual field defects. The association of normal
82:, while intraocular pressure is normal. Many patients with normal tension glaucoma have a basic constitution, which corresponds to the Flammer syndrome. Some of its features were formerly summarized under the term "primary vascular dysregulation syndrome".
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Having
Flammer syndrome does not necessarily mean that an individual is sick. Most of those affected are and remain healthy. Certain diseases such as arteriosclerosis and its consequences are probably even rarer. Best known is the higher risk of
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Yeghiazaryan K, Flammer J, OrgĂĽl S, Wunderlich K, Golubnitschaja O.: Vasospastic individuals demonstrate significant similarity to glaucoma patients as revealed by gene expression profiling in circulating leukocytes. Mol Vis. 2009;15:
223:
Konieczka, Katarzyna; Ritch, Robert; Traverso, Carlo Enrico; Kim, Dong Myung; Kook, Michael Scott; Gallino, Augusto; Golubnitschaja, Olga; Erb, Carl; Reitsamer, Herbert A; Kida, Teruyo; Kurysheva, Natalia; Yao, Ke (2014-07-08).
332:
Vollenweider, S; Wirz-Justice, A; et al. (Feb 2008). "Chronobiological characterization of women with primary vasospastic syndrome: body heat loss capacity in relation to sleep initiation and phase of entrainment".
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blood pressure, especially during sleep, can often be prevented. These nightly "dips" of blood pressure in normal tension glaucoma patients with
Flammer syndrome can significantly damage the sensory cells of the retina.
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Kräuchi, K; Gasio, PF; Vollenweider, S; et al. (Dec 2008). "Cold extremities and difficulties initiating sleep: evidence of co-morbidity from a random sample of a Swiss urban population".
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Quill B, Henry E, Simon E, O'Brien C: Evaluation of the Effect of
Hypercapnia on Vascular Function in Normal Tension Glaucoma. Biomed Res Int 2015, published online October 18
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cold. Patients with vasospastic symptoms characteristic of
Flammer syndrome have shown a unique gene expression when their lymphocytes underwent gene expression profiling.
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is a described clinical entity comprising a complex of clinical features caused mainly by dysregulation of the blood supply. It was previously known as
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seem to have
Flammer syndrome quite frequently, and possible associations with the vascular factor endothelin-1 are under investigation.
841:
Todorova, M.G.; et al. (2015). "Endothelin-1 Plasma Levels in
Patients with both Retinitis Pigmentosa and Flammer Syndrome".
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have been known, particularly in the vessels supplying the retina with blood. These vasospasms are temporary narrowings of
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Kim, KE; Park, KH (2016). "Update on the Prevalence, Etiology, Diagnosis, and Monitoring of Normal-Tension Glaucoma".
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People with Flammer syndrome sleep poorly and have a decreased sensation of thirst.
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1033:"The discovery of the Flammer syndrome: a historical and personal perspective"
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Nakazawa, T (2016). "Ocular Blood Flow and Influencing Factors for Glaucoma".
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excessive response to mental or physical stimuli such as stress or cold
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Konieczka K, Fränkl S. Primary Vascular Dysregulation and Glaucoma.
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Fang, Lei; Baertschie, Michael; Mozaffarieh, Manneli (2014).
58:. Flammer syndrome is named after the Swiss ophthalmologist
792:"The effect of Flammer syndrome on retinal venous pressure"
555:"The effect of flammer-syndrome on venous retinal pressure"
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Konieczka, Katarzyna; Ritch, Robert; et al. (2014).
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Konieczka, Katarzyna; Ritch, Robert; et al. (2014).
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reversible patchy white or red discoloration of the skin
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The disease is more prevalent in the following groups:
604:Wojcik-Gryciuka, A; Skup, M; Waleszczyk, M (2016).
427:Flammer, J.; Konieczka, K.; Flammer, A. J. (2013).
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982:Flammer, J; Konieczka, K; et al. (May 2013).
790:Fang, L; Baertschi, M; Mozaffarieh, M (Oct 2014).
935:Konieczka, K.; Fränkl, S.; et al. (2014). "
655:"Ocular Blood Flow and Normal Tension Glaucoma"
606:"Glaucoma – state of the art and perspectives"
140:in academics compared with blue collar-workers
1031:Flammer, Josef; Konieczka, Katarzyna (2017).
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1081:Scientific essay on Flammer syndrome
937:Unstable oxygen supply and glaucoma.
134:in people with lower blood pressure
101:prolongation of time to fall asleep
85:Signs of Flammer syndrome include:
137:in Asians compared with Caucasians
16:Syndrome of vascular dysregulation
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1076:On Flammer syndrome and glaucoma
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289:British Journal of Ophthalmology
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761:10.1097/apo.0000000000000183
718:10.1097/apo.0000000000000177
107:sensitivity to certain drugs
1071:Website on Flammer syndrome
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89:cold hands or feet, or both
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285:"Vasospasm and glaucoma"
131:in women compared to men
984:"The Eye and the Heart"
749:Asia Pac. J. Ophthalmol
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164:normal tension glaucoma
56:normal tension glaucoma
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395:10.1186/1878-5085-5-11
283:O'Brien, Colm (1998).
243:10.1186/1878-5085-5-11
48:vascular dysregulation
157:Clinical significance
95:lower body mass index
301:10.1136/bjo.82.8.855
172:retinitis pigmentosa
92:arterial hypotension
74:In many people with
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195:For over 100 years
886:"Flammer syndrome"
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378:"Flammer syndrome"
226:"Flammer syndrome"
66:Signs and symptoms
52:low blood pressure
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