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76 Idiopathic-intracranial-hypertension-without-papilloedema (IIHWOP) leading to a prolong history of fibromyalgia and myalgic encephalomyelitis
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Abstract
BackgroundFibromyalgia and myalgic encephalomyelitis (ME) are chronic conditions characterized by widespread pain, fatigue, and cognitive disturbances. Idiopathic-intracranial-hypertension-without-papilloedema (IIHWOP) is a rare form of IIH characterized by the absence of papilloedema.
Case history
A 38-year-old obese (body mass index: 38 kg/m²) Black African female with a 5-year history of fibromyalgia and ME presented with persistent musculoskeletal pain, fatigue, brain fog, and unrefreshing sleep. Her pain was comparatively better when standing than when lying down, raising suspicion of elevated intracranial pressure. Neurological examination, including fundoscopy, was unremarkable. Brain MRI showed an empty sella, distension of the perioptic subarachnoid space, and transverse venous sinus stenosis. Cerebrospinal fluid (CSF) opening pressure was 32 cmCSF. Endocrine workup was unremarkable. These findings suggested IIHWOP. The patient was treated with topiramate, and with lifestyle adjustments, she achieved a 20% weight reduction, leading to significant improvement in fibromyalgia and ME symptoms.
Conclusion
It is recognized that IIH may be associated with fibromyalgia and ME. The absence of papilledema and typical IIH clinical features makes it challenging to consider raised intracranial pressure as the underlying cause. However, pain variation with posture and typical IIH phenotype can be important clues, prompting further investigations.
sathyajith.ambawatte@gmail.com
https://doi.org/10.1136/jnnp-2025-ABN.76