Borderline Intracranial Hypertension Manifesting as Chronic Fatigue Syndrome Treated by Venous Sinus Stenting, 2015, Pickard et al

[Utsikt]

Borderline Intracranial Hypertension Manifesting as Chronic Fatigue Syndrome Treated by Venous Sinus Stenting

Pickard, John; Lever, Andrew; Higgins, Nicholas

Abstract
Chronic fatigue syndrome and cases of idiopathic intracranial hypertension without signs of raised intracranial pressure can be impossible to distinguish without direct measurement of intracranial pressure. Moreover, lumbar puncture, the usual method of measuring intracranial pressure, can produce a similar respite from symptoms in patients with chronic fatigue as it does in idiopathic intracranial hypertension.

This suggests a connection between them, with chronic fatigue syndrome representing a forme fruste variant of idiopathic intracranial hypertension. If this were the case, then treatments available for idiopathic intracranial hypertension might be appropriate for chronic fatigue.

We describe a 49-year-old woman with a long and debilitating history of chronic fatigue syndrome who was targeted for investigation of intracranial pressure because of headache, then diagnosed with borderline idiopathic intracranial hypertension after lumbar puncture and cerebrospinal fluid drainage.

Further investigation showed narrowings at the anterior ends of the transverse sinuses, typical of those seen in idiopathic intracranial hypertension and associated with pressure gradients.

Stenting of both transverse sinuses brought about a life-changing remission of symptoms with no regression in 2 years of follow-up.

This result invites study of an alternative approach to the investigation and management of chronic fatigue.

Web | DOI | PMC | PDF | Journal of Neurological Surgery Reports

 

[Tom Hill]

Thanks for making this thread. I’d be really interested in reactions from researchers with knowledge of the various overlaps in inquiry.

 

[bicentennial]

Chronic fatigue syndrome and cases of idiopathic intracranial hypertension without signs of raised intracranial pressure can be impossible to distinguish without direct measurement of intracranial pressure.

What are the signs of intracranial pressure? Is there no sign in any case or only in the cases referenced? Are there signs one might sense, perceive or deduce? Is there ever any sensation of it?

Does intracranial pressure have anything to do with soundwaves, reduced blood-flow, or low blood pressure? Can it arise with altered parameters of general circulation eg an altered density, volume, viscosity, and flow-rate? What over-contracts blood vessels? Are there valves inside the brain?

I cannot easily picture pressure gradients. Is it at all hydraulic?