Lumbar puncture, chronic fatigue syndrome and idiopathic intracranial hypertension: a cross-sectional study, 2 Dec 2013, Higgins et al

[forestglip]

Lumbar puncture, chronic fatigue syndrome and idiopathic intracranial hypertension: a cross-sectional study

Authors: Nicholas Higgins, John Pickard, Andrew Lever

Abstract
Objective
Unsuspected idiopathic intracranial hypertension (IIH) is found in a significant minority of patients attending clinics with named headache syndromes, if it is specifically sought out. Chronic fatigue syndrome is frequently associated with headache. Could the same be true of chronic fatigue? Moreover, there are striking similarities between the two conditions. Could they be related? Attempting to answer these questions, we describe the results of a change in clinical practice aimed at capturing patients with chronic fatigue who might have IIH.

Design
Cross-sectional.

Setting
Hospital outpatient and radiology departments.

Participants
Patients attending a specialist clinic with chronic fatigue syndrome and headache who had lumbar puncture to exclude raised intracranial pressure.

Main outcome measures
Intracranial pressure measured at lumbar puncture and the effect on headache of cerebrospinal fluid drainage.

Results
Mean cerebrospinal fluid pressure was 19 cm H2O (range 12–41 cm H2O). Four patients fulfilled the criteria for IIH. Thirteen others did not have pressures high enough to diagnose IIH but still reported an improvement in headache after drainage of cerebrospinal fluid. Some patients also volunteered an improvement in other symptoms, including fatigue. No patient had any clinical signs of raised intracranial pressure.

Conclusions
An unknown, but possibly substantial, minority of patients with chronic fatigue syndrome may actually have IIH. An unknown, but much larger, proportion of patients with chronic fatigue syndrome do not have IIH by current criteria but respond to lumbar puncture in the same way as patients who do. This suggests that the two conditions may be related.

 

[forestglip]

CSF withdrawal produced a symptomatic improvement in 17 patients, that is in all five patients whose CSF pressures were greater than 20 cm H2O and in 12 patients whose pressures were between 12 and 20 cm H2O. This improvement usually developed during, or soon after the procedure and lasted from a few minutes to several weeks. It generally took the form of reduced headache, a heightened alertness and a reduced sense of fatigue (Table 2).

Table 2. The effect of CSF drainage at lumbar puncture on headache in 20 patients with chronic fatigue.

Eleven patients developed low pressure headaches. These usually became apparent the day after lumbar puncture and in some cases were severe, lasting up to two weeks. Some patients who had shown early improvement before the onset of low pressure symptoms recovered the benefit for a time once low pressure symptoms had resolved.