Looking for idiopathic intracranial hypertension in patients with CFS

[Firestormm]

Now, I am no science- but this one does look intriguing to me. The full paper is easily accessed from HERE in the current issue of the open-access Journal of Observational Pain Medicine. It's a small study though one that should perhaps be considered for a larger effort? I don't know...

Looking for idiopathic intracranial hypertension in patients with chronic fatigue syndrome

Dr Nicholas Higgins FRCP FRCR,1 Prof. John Pickard F Med Sci,2 Prof. Andrew Lever F Med
Sci3

Abstract

Introduction:

Headache is common in chronic fatigue syndrome, a condition of unknown cause in which there are no clinical signs. Fatigue is common in idiopathic intracranial hypertension, a headache condition of unknown cause in which the only clinical signs are those of raised intracranial pressure, signs which may be absent.

Might, therefore, idiopathic intracranial hypertension be present in some patients diagnosed with chronic fatigue syndrome? Could the two conditions be related?

Patients and methods:

From June 2007, patients attending a specialist clinic who fulfilled the diagnostic criteria for chronic fatigue syndrome and in whom headache was an especially prominent symptom were offered CT venography and lumbar puncture, looking for evidence of raised intracranial pressure.

Results:

Of the 20 patients who accepted lumbar puncture, eight had pressures of 20 cm H2O or greater, including three who had pressures of 25 cm H2O or greater. Mean pressure was 19 cm H2O.

Conclusions:

Some patients with headache and a diagnosis of chronic fatigue syndrome have unrecognised and occult idiopathic intracranial hypertension. The possibility that the two conditions are related cannot be excluded.

Dr Shepherd also noted that the full paper carries the acknowledgement:

Earlier versions of this article were rejected by The Lancet, Archives of Internal Medicine, The British Journal of Psychiatry, Cephalalgia and BMJ Open. We are grateful to the editors of these journals and to their reviewers, as well as to the editor and reviewers of the JoOPM, for their comments, which have allowed us to answer some of their concerns in the current version, even if not completely resolving them.

Am off to read the full paper now.....

 

[John H Wolfe]

'Paradoxical' OH-SH is a quirk I've experienced myself, particularly as I've started to tackle my POTS more routinely/robustly and to experiment with postural conditions:- got my bed set up (bed wedge and over-bed table) so I can have 'productive' semi-recumbent 'rest' (not quite rest but less orthostatic stress at least!)

- - -

OH-SH Paradox: Some ME/CFS patients experience supine (lying) hypertension (high blood pressure), often along with orthostatic intolerance: hypotension (low blood pressure). PWME ought therefore to take a two-pronged approach to managing OI: avoiding prolonged periods spent standing still and avoiding lying down as much as possible during the day

Many PWME wake with a headache and this may, relate to cerebral hypertension induced in a supine sleeping position, another reason not to oversleep! Transdermal nitroglycerin(smooth muscle relaxant) patches are sometimes issued to provide some relief. This supine hypertensive capacity may unfortunately be enhanced, initially at least, by efforts to mitigate against the effects of OI and nerve sensitisation by adopting recumbent/raised leg positions