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Intracranial hypertension
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==Related conditions== {{Video|id=https://www.youtube.com/watch?v=FV92prEwfUY|service=youtube|dimensions=550|description=Dr. Kenneth Liu describes stenting in EDS patients with intracranial hypertension.|alignment=right|urlargs=}}It has been observed by some clinicians that ME/CFS and [[Ehlers-Danlos syndrome]] patients may have borderline or subclinical intracranial hypertension and benefit from IIH treatments such as Diamox, venous stents, or shunts. While these treatments are rarely used by ME/CFS clinicians they are more commonly employed in the clinical care of EDS patients. ===ME/CFS === A case study of a woman presenting with symptoms of CFS and pressure [[headache]], who was diagnosed with borderline intracranial hypertension, found that her CFS symptoms resolved with the placement of a transverse sinus stent.<ref name="Tanaka2002">{{Cite journal | title = Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance | date = 2002-04-01 | url = https://www.sciencedirect.com/science/article/pii/S0022347602157878|journal=The Journal of Pediatrics|volume=140|issue=4 | pages = 412–417 | last = Tanaka | first = Hidetaka | last2 = Matsushima | first2 = Reiko | last3 = Tamai | first3 = Hiroshi | last4 = Kajimoto | first4 = Yoshinaga|language=en|doi=10.1067/mpd.2002.122725|issn=0022-3476}}<span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Pediatrics&rft.atitle=Impaired+postural+cerebral+hemodynamics+in+young+patients+with+chronic+fatigue+with+and+without+orthostatic+intolerance&rft.volume=140&rft.issue=4&rft.pages=412-417&rft.date=2002-04-01&rft_id=info%3Adoi%2F10.1067%2Fmpd.2002.122725&rft.issn=0022-3476&rfr_id=info%3Asid%2Fme-pedia.org%3AIntracranial+hypertension" class="Z3988"></span></ref> A cross-sectional study of twenty patients presenting at a headache clinic found that a large proportion of patients had borderline intracranial hypertension, with four meeting the diagnostic criteria for IIH (mean cerebrospinal fluid pressure was 19 cm H<sub>2</sub>O (range 12–41 cm H<sub>2</sub>O); however, none had clinical signs of IIH. Cerebrospinal fluid drainage via lumbar puncture improved symptoms in 17/20 patients.<ref name="Higgins2013">{{Cite journal | last = Higgins | first = Nicholas | last2 = Pickard | first2 = John | last3 = Lever | first3 = Andrew | date = 2013-11-21 | title = Lumbar puncture, chronic fatigue syndrome and idiopathic intracranial hypertension: a cross-sectional study | url = http://journals.sagepub.com/doi/pdf/10.1177/2042533313507920|journal=JRSM Short Reports|language=en|volume=4|issue=12 | pages = 204253331350792|doi=10.1177/2042533313507920|issn=2042-5333|pmc=3899735|pmid=24475346}}</ref> Researchers speculate that a subset of CFS patients may have borderline cases of idiopathic intracranial hypertension without papillodema, that is, swelling of the optic nerve.<ref name="Higgins2017">{{Cite journal | last = Higgins | first = J. Nicholas P. | last2 = Pickard | first2 = JohnD. | last3 = Lever | first3 = Andrew M.L. | date = Aug 2017 | title = Chronic fatigue syndrome and idiopathic intracranial hypertension: Different manifestations of the same disorder of intracranial pressure? | url = https://www.ncbi.nlm.nih.gov/pubmed/28735654|journal=Medical Hypotheses|volume=105 | pages = 6–9|doi=10.1016/j.mehy.2017.06.014|issn=1532-2777|pmid=28735654}}</ref> The 2019 Bertilsson/Bragée study<ref name="Bragee2019">{{Cite journal | last = Bragée | first = Björn | last2 = Michos | first2 = Anastasios | last3 = Drum | first3 = Brandon | last4 = Fahlgren | first4 = Mikael | last5 = Szulkin | first5 = Robert | last6 = Bertilson | first6 = Bo C. | date = 2020-08-28 | title = Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | url = https://www.frontiersin.org/article/10.3389/fneur.2020.00828/full|journal=Frontiers in Neurology|volume=11 | pages = 828|doi=10.3389/fneur.2020.00828|issn=1664-2295}}</ref> found evidence of IH in ME/CFS patients meeting the [[Canadian Consensus Criteria]]. Of 205 patients who underwent brain MRIs, 171 (83%) had an optic nerve sheath diameter/eyeball transverse diameter quotient (ONSD/ETD) >0.22, where the maximum found in healthy patients is 0.23.<ref name="Kim2017">{{Cite journal | last = Kim | first = Dong Hwan | last2 = Jun | first2 = Jin-Sun | last3 = Kim | first3 = Ryul | date = Dec 2017 | title = Ultrasonographic measurement of the optic nerve sheath diameter and its association with eyeball transverse diameter in 585 healthy volunteers | url = http://www.nature.com/articles/s41598-017-16173-z|journal=Scientific Reports|language=en|volume=7|issue=1|pages=15906|doi=10.1038/s41598-017-16173-z|issn=2045-2322|pmc = 5698472|pmid=29162911|quote=|via=}}</ref> Eighty-seven patients (42%) had an ONSD/ETD > 0.25, which is the threshold for pathological.<ref name="Du2020">{{Cite journal | last = Du | first = Jie | last2 = Deng | first2 = Yanjun | last3 = Li | first3 = Hua | last4 = Qiao | first4 = Shigang | last5 = Yu | first5 = Mengnan | last6 = Xu | first6 = Qingya | last7 = Wang | first7 = Chen | date = Apr 2020 | title = Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasound Can Predict Intracranial Hypertension in Traumatic Brain Injury Patients: A Prospective Study | url = http://link.springer.com/10.1007/s12028-019-00762-z|journal=Neurocritical Care|language=en|volume=32|issue=2 | pages = 478–485|doi=10.1007/s12028-019-00762-z|issn=1541-6933|pmc=|pmid=|quote=|via=}}</ref> Of 125 patients who underwent a cervical spine MRI, 100 (80%) has some form of obstruction capable of increasing pressure- e.g. spondylolisthesis, osteophytes, cysts, syrinxes. 13.2% had tonsillar herniations severe enough to be considered a [[Chiari malformation|Chiari Malformation]].<ref name="Bragee2019" /> ===Ehlers-Danlos syndrome=== A number of EDS neurosurgeons have observed an association between intracranial hypertension and EDS.<ref name="Henderson2017">{{Cite journal | last = Henderson | first = Fraser C. | last2 = Austin | first2 = Claudiu | last3 = Benzel | first3 = Edward | last4 = Bolognese | first4 = Paolo | last5 = Ellenbogen | first5 = Richard | last6 = Francomano | first6 = Clair A. | last7 = Ireton | first7 = Candace | last8 = Klinge | first8 = Petra | last9 = Koby | first9 = Myles | date = 2017 | title=Neurological and spinal manifestations of the Ehlers–Danlos syndromes | url = https://onlinelibrary.wiley.com/doi/abs/10.1002/ajmg.c.31549|journal=American Journal of Medical Genetics Part C: Seminars in Medical Genetics|language=en|volume=175|issue=1|pages=195–211|doi=10.1002/ajmg.c.31549|issn=1552-4876}}</ref> Penn State vascular neurosurgeon, Dr. [[Kenneth Liu]], has presented case studies of patients with EDS whose symptoms improve with venous stenting.<ref>{{Cite web | url = https://vimeo.com/190164038 | title = Venous Stenting in Intracranial Hypertension | last = Liu | first = Kenneth | date = |website=|archive-url=|archive-date=|url-status=|access-date=}}</ref>
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