Chronic fatigue syndrome and idiopathic intracranial hypertension: Different manifestations of the same disorder of intracranial, 2017, Higgins et al

[Andy]

Chronic fatigue syndrome and idiopathic intracranial hypertension: Different manifestations of the same disorder of intracranial pressure?

Though not discussed in the medical literature or considered in clinical practice, there are similarities between chronic fatigue syndrome and idiopathic intracranial hypertension (IIH) which ought to encourage exploration of a link between them. The cardinal symptoms of each – fatigue and headache – are common in the other and their multiple other symptoms are frequently seen in both. The single discriminating factor is raised intracranial pressure, evidenced in IIH usually by the sign of papilloedema, regarded as responsible for the visual symptoms which can lead to blindness. Some patients with IIH, however, do not have papilloedema and these patients may be clinically indistinguishable from patients with chronic fatigue syndrome. Yet IIH is rare, IIH without papilloedema (IIHWOP) seems rarer still, while chronic fatigue syndrome is common. So are the clinical parallels spurious or is there a way to reconcile these conflicting observations?

We suggest that it is a quirk of clinical measurement that has created this discrepancy. Specifically, that the criteria put in place to define IIH have led to a failure to appreciate the existence, clinical significance or numerical importance of patients with lower level disturbances of intracranial pressure. We argue that this has led to a grossly implausible distortion of the epidemiology of IIH such that the milder form of the illness (IIHWOP) is seen as less common than the more severe and that this would be resolved by recognising a connection with chronic fatigue syndrome.

We hypothesise, therefore, that IIH, IIHWOP, lesser forms of IIH and an undetermined proportion of chronic fatigue cases are all manifestations of the same disorder of intracranial pressure across a spectrum of disease severity, in which this subset of chronic fatigue syndrome would represent the most common and least severe and IIH the least common and most extreme.

Full text available at https://www.medical-hypotheses.com/article/S0306-9877(17)30418-8/fulltext

Has inspired this letter

We read with great interest the paper recently published in Medical Hypotheses by Higgins et al. [1] and would appreciate the opportunity to make a comment. The authors measured cerebrospinal fluid (CSFacrnm1) pressure by lumbar puncture in twenty...

Full letter paywalled at https://www.clinicalkey.com/#!/cont...0306987718302895?returnurl=null&referrer=null

 

[Hutan]

We have tested this point in a small number patients (n = 20) diagnosed with chronic fatigue syndrome (in whom headache was a prominent symptom) and found that 10% had unequivocal IIH according to current criteria – specifically IIHWOP – when it was sought out with lumbar puncture [11]. We also found that the mean CSF pressure in the group (19 cm H2O) was towards the high end of normal. More importantly, we found that, regardless of whether the opening pressure matched IIH criteria, when intracranial pressure was reduced by drainage of CSF, 85% of patients reported an amelioration of symptoms, including fatigue [12].

This is an interesting paper. The authors do acknowledge possible issues with a placebo effect with the reported improvement.

It would be good if people with long standing CFS had cerebrospinal fluid pressures measured. It's not something that has ever been suggested to me even though I have sometimes reported frequent headaches and a feeling of head pressure.

@Andy, what did the letter say?

 

[Andy]

@Andy, what did the letter say?

My internet provider blocks Sci Hub unfortunately, so I've posted all that I know I'm afraid.

 

[hixxy]

My internet provider blocks Sci Hub unfortunately, so I've posted all that I know I'm afraid.

Can't you just get around that by using different DNS servers? That works in Australia and is very easy to do.

 

[Lisa108]

sci hub link

 

[Seven]

I think yet again this is a sub group, I also believe some of us have another cause for the leak.
I got my pressure meassure and it was ok. But I could swear I have leaks. I get this bump, pressure like and a few days later I feel some liquid spilled. Burns like hell, kind of like head acid reflux. Then my bump goes down. I do not get the regular leak headaches. Sometimes picking or like 25 cent round pain, hard to explain but it is always localized. I do not leak very often (I do not get the salty liquid either on throat).
But I think some imflamtion is causing the leak not the pressure per say.