J Neurol Surg Rep 2015; 76(02): e244-e247
DOI: 10.1055/s-0035-1564060
Case Report
Georg Thieme Verlag KG Stuttgart · New York

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

Nicholas Higgins
1  Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
John Pickard
2  Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
Andrew Lever
3  Department of Infectious diseases, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
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05. Juni 2015

17. Juli 2015

14. September 2015 (online)


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.