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1511 - “Blurred Lines: The Overlooked Impact of Glaucoma in Stroke Rehabilitation”

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

OM

Ojirese O. Momoh, DO

Physician
Mercy Hospital
New York, New York, United States

Co-Author(s)

MS

Michael Schloss, DO

Pain Medicine Fellow
University of Alabama
Rockville Centre, New York, United States
SB

Samira Bahrami Tabar, MD/DO

Resident Physician
Jefferson Einstein Residency Program
Philadelphia, Pennsylvania, United States
Benjamin W. Cooper, DO

Resident Physician
Mercy Hospital
Long Island City, New York, United States
RS

Robert Squires, DO

Resident Physician
Mercy Hospital
Rockville Centre, New York, United States
LS

Lauren Stimler-Levy, MD

Attending Physician
Mercy Hospital
Rockville Centre, New York, United States
BC

Ben A. Cruci, DO

Resident Physician
Mercy Hospital
Rockville Centre, New York, United States

Case Diagnosis: Open Angle Glaucoma

Case Description: A 78-year-old black male with PMH of cerebellar infarct, CAD, hypertension, hyperlipidemia, pulmonary embolism, obstructive sleep apnea, and glaucoma. MRI showed multiple subacute infarcts in the right cerebellum. Admitted to AIR, he experienced several episodes of dizziness, headaches, and imbalance. Managed with meclizine, scopolamine patches, and acetaminophen. A workup for causation included imaging and an ophthalmology consult. MRI of the brain revealed worsening intraocular pressure consistent with glaucoma, and the patient was prescribed Dorzolamide to reduce the amount of fluid in the eye. This improved his vision and balance.

Discussions:

The patient had a history of glaucoma, which may have contributed to their gait abnormality and imbalance during acute rehab post-infarct. Elevated intraocular pressure is a risk factor for glaucoma and is correlated with mean arterial pressure. The patient's high intraocular pressure may have been influenced by hypertension and high-dose steroids. The patient's tonometry findings showed an abnormal intraocular pressure in the right eye, indicating the need for a change in their medical regimen. Patient's ophthalmologist recommended the addition of dorzolamide with the aim to manage the elevated intraocular pressure and mitigate the risk of further visual impairment.

Conclusions:

Patients with multiple risk factors including ischemic stroke, hypertension with a positive correlation to glaucoma, and glaucoma being the leading cause of irreversible blindness in hispanic and black patients, it is crucial to consider elevated intraocular pressure in patients experiencing stroke and persistent because their symptoms overlap. Our patient underwent numerous tests and that may have helped alleviate symptoms but made his time on the acute rehab floor more challenging. During the acute rehabilitation phase, it is crucial careful consideration be given to polypharmacy, as it can impact mobility and strength, and it is essential to avoid neglecting comorbidities that may complicate recovery.