Higgins Nicholas, Pickard John D, Lever Andrew M
Department of Radiology, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
Academic Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK; University of Cambridge, Cambridge, UK.
EJMINT. 2014 Nov 24;2014.
Similarities between chronic fatigue syndrome and idiopathic intracranial hypertension (IIH) invite speculation that they may be related. Cranial venous outflow obstruction plays a role in the development of IIH. Could it be a factor in chronic fatigue? This paper attempts to evaluate an investigative approach to chronic fatigue syndrome that allows for this possibility.
Since 2007, patients attending a specialist clinic at our institution diagnosed with chronic fatigue syndrome and with prominent headache have been offered CT venography, lumbar puncture and a trial of cerebrospinal fluid withdrawal looking for IIH. Also, if CT venography revealed focal narrowing of the jugular veins, patients were offered catheter cerebral venography and jugular venoplasty attempting to establish their clinical significance.
In the 29 patients investigated to date, the mean cerebrospinal fluid (CSF) pressure was 19 cm H2O (range 12 - 41 cm H2O). Twenty-five patients responded positively to CSF withdrawal and in 5 the CSF pressures were high enough to allow an unequivocal diagnosis of IIH while in the remaining 20, symptoms improved with lumbar puncture even though CSF pressures were within the normal range. Twenty-one patients had focal narrowing of one or both internal jugular veins on CT venography. Fourteen of these have had jugular venoplasty, all of whom reported an improvement in symptoms afterwards lasting from a few minutes to more than 1 month.
Chronic fatigue syndrome may represent an incomplete form of IIH. Cranial venous outflow obstruction deserves further investigation as a possible aetiological factor.
慢性疲劳综合征与特发性颅内高压（IIH）之间的相似性引发了它们可能存在关联的推测。颅内静脉流出道梗阻在IIH的发病过程中起作用。它会是慢性疲劳的一个因素吗？本文试图评估一种针对慢性疲劳综合征的调查方法，该方法考虑到了这种可能性。
自2007年以来，在我们机构专科门诊被诊断为慢性疲劳综合征且伴有明显头痛的患者接受了CT静脉造影、腰椎穿刺以及脑脊液引流试验以寻找IIH。此外，如果CT静脉造影显示颈静脉局部狭窄，患者会接受导管脑血管造影和颈静脉血管成形术，试图确定其临床意义。
在迄今为止接受调查的29例患者中，脑脊液（CSF）平均压力为19 cm H2O（范围为12 - 41 cm H2O）。25例患者对脑脊液引流有阳性反应，其中5例脑脊液压力高到足以明确诊断为IIH，而在其余20例中，尽管脑脊液压力在正常范围内，但腰椎穿刺后症状有所改善。21例患者在CT静脉造影中显示一侧或双侧颈内静脉局部狭窄。其中14例接受了颈静脉血管成形术，所有患者术后均报告症状改善，持续时间从几分钟到1个月以上不等。
慢性疲劳综合征可能代表IIH的一种不完全形式。颅内静脉流出道梗阻作为一种可能的病因值得进一步研究。
