TGI Friday! Our weekly round-up of recently published research abstracts | 14 November 2015

November 14, 2015

From the Journal of Neurological Surgery Reports, 14 September 2015 (published before print, full text available).

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

Nicholas Higgins(1), John Pickard(2), Andrew Lever(3)
1) Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
2) Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
3) Department of Infectious Diseases, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom


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.

From Perception, 3 November 2015.

Increased Vulnerability to Pattern-Related Visual Stress in Myalgic Encephalomyelitis

Rachel L. Wilson, Kevin B. Paterson, Claire V. Hutchinson*
College of Medicine, Biological Sciences and Psychology, University of Leicester, UK.
* Claire V. Hutchinson, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester LE1 9HN, UK. Email:


The objective of this study was to determine vulnerability to pattern-related visual stress in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A total of 20 ME/CFS patients and 20 matched (age, gender) controls were recruited to the study.

Pattern-related visual stress was determined using the Pattern Glare Test. Participants viewed three patterns, the spatial frequencies (SF) of which were 0.3 (low-SF), 2.3 (mid-SF), and 9.4 (high-SF) cycles per degree (c/deg). They reported the number of distortions they experienced when viewing each pattern.

ME/CFS patients exhibited significantly higher pattern glare scores than controls for the mid-SF pattern. Mid-high SF differences were also significantly higher in patients than controls.

These findings provide evidence of altered visual perception in ME/CFS. Pattern-related visual stress may represent an identifiable clinical feature of ME/CFS that will prove useful in its diagnosis. However, further research is required to establish if these symptoms reflect ME/CFS-related changes in the functioning of sensory neural pathways.

From Jacobs Journal of Physiology, 7 November 2015 (open access).

Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome

Frank N.M. Twisk(1*), Keith J. Geraghty(2)
1) ME-de-patiënten Foundation, Limmen, Netherlands
2) Institute of Population Health, School of Community Based Medicine, University of Manchester, United Kingdom.
*Corresponding author: Frank N.M. Twisk, MBA BEd BEc, ME-de-patiënten Foundation, Zonnedauw 15, Limmen, Netherlands, Tel: +31-72-505 4775; Email:


Post-exertional “malaise” is a hallmark symptom of Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). Various abnormalities, including abnormal physiological responses to exertion, can account for post-exertional “malaise” and “exercise avoidance”.

Since these abnormalities are not observed in sedentary healthy controls, the abnormalities and deviant responses cannot be explained by “exercise avoidance” and subsequent deconditioning, nor by psychogenic factors.

From the Journal of Health Psychology, 4 November 2015.

An assessment of fatigue in patients with postural orthostatic tachycardia syndrome

Shelby Wise(1,*), Amanda Ross(2), Abigail Brown(1), Meredyth Evans(1), Leonard Jason(1)
1) DePaul University, USA
2) Johns Hopkins Medical College, USA
* Shelby Wise, DePaul University, 990 W Fullerton Ave, Suite 3100, Chicago, IL 60614, USA. Email:


Individuals with postural orthostatic tachycardia syndrome share many symptoms with those who have chronic fatigue syndrome; one of which is severe fatigue. Previous literature found that those with chronic fatigue syndrome experience many forms of fatigue.

The goal of this study was to investigate whether individuals with postural orthostatic tachycardia syndrome also experience multidimensional fatigue and whether these individuals can be clustered into subgroups based on the types of fatigue they endorse.

A convenience sample of 138 participants (aged 14–29) with postural orthostatic tachycardia syndrome completed questionnaires that assessed fatigue, brain fog symptom severity, activities that improve brain fog, and brain fog-related disability.

An exploratory factor analysis was conducted on the Fatigue Types Questionnaire, and a three-factor solution was produced. Factor scores were then used to cluster the patients into groups using a TwoStep cluster analysis. This resulted in two clusters, a high severity group and a low severity group. The clusters were then compared on a number of items related to symptom expression.

Individuals within the more severe cluster had significantly more brain fog at the beginning and end of the survey when compared to cluster two. Those in the more severe cluster also described more activity impairment as well as more frequent, more severe, and more debilitation from postural orthostatic tachycardia syndrome and brain fog.

The findings of the factor analysis suggest that patients with postural orthostatic tachycardia syndrome experience fatigue as a multidimensional construct and they also can be subgrouped based on symptom severity.

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