Life changing response to successive surgical interventions on cranial venous outflow: A case report on chronic fatigue syndrome.
Higgins, J Nicholas P, Axon, Patrick R, Lever, Andrew M L · Frontiers in neurology · 2023 · DOI
Quick Summary
This case report describes one patient with ME/CFS who had narrowing in the veins that drain blood from the brain. Surgery to open one of these narrowed veins led to significant improvement in fatigue and other symptoms over the follow-up period. The authors suggest that blocked brain venous drainage might explain ME/CFS symptoms in some patients, similar to a related condition called intracranial hypertension.
Why It Matters
This study offers a testable mechanistic hypothesis for ME/CFS that could explain symptom overlap with IIH and directs attention to cranial venous hemodynamics as a potential therapeutic target. If venous obstruction contributes to ME/CFS in a subset of patients, imaging and surgical intervention might become viable diagnostic and treatment options, though this requires validation in larger patient cohorts.
Observed Findings
Imaging revealed focal narrowings of bilateral jugular veins and the left brachiocephalic vein in a patient with ME/CFS and headache
Surgical relief of jugular venous obstruction in two separate procedures produced incremental and significant clinical improvements
Clinical improvements persisted over the length of follow-up
Brachiocephalic venous obstruction was not amenable to surgical treatment
Symptom profile included disabling fatigue, headache, and other features overlapping with IIH
Inferred Conclusions
Cranial venous outflow obstruction may represent a treatable pathophysiological substrate in select ME/CFS cases
ME/CFS may exist on a spectrum with IIH, potentially linked by venous hemodynamic disturbance
Imaging evaluation of cranial venous drainage should be considered in ME/CFS patients with prominent headache and disproportionate disability
Venous decompression surgery may offer durable clinical benefit in appropriately selected patients
Remaining Questions
How prevalent is cranial venous obstruction among the broader ME/CFS patient population, and what imaging criteria should guide screening?
What This Study Does Not Prove
This case report does not prove that cranial venous obstruction causes ME/CFS or is present in most or many ME/CFS patients—it describes only one patient's response to treatment. The improvement observed does not establish whether venous obstruction is the primary cause of symptoms or merely a contributing factor. Without control groups or larger population studies, the generalizability to other ME/CFS patients remains unknown.
Tags
Symptom:Fatigue
Biomarker:Neuroimaging
Method Flag:No ControlsSmall SampleExploratory Only