Tag: cerebrospinal fluid pressure

Cerebrospinal fluid opening pressure in relation to symptomatology and craniocervical anatomy in patients with myalgic encephalomyelitis/chronic fatigue syndrome

Abstract:

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disease that affects millions worldwide. Its cause remains unknown, although many physiological mechanisms are impaired. Structural abnormalities in the craniocervical region seem to be more prevalent in patients with ME/CFS, with a possible impact on intracranial pressure (ICP) and lumbar puncture (LP) measurements. This study aimed to quantify the occurrence of elevated cerebrospinal fluid (CSF) opening pressure and a possible association with clinical symptoms and radiological variables in craniocervical segments in a cohort of patients with ME/CFS.

Methods: This study included 34 patients previously diagnosed with ME/CFS as part of a larger case-control study, for whom LP was performed only in the case group. Key measurements included age, sex, opening pressure from LP, symptomatic relief post-LP, and radiological variables with potential influence on CSF dynamics. Individuals were stratified into two groups according to opening pressure (OP) measurements using 20 cmH2O as the cutoff value, with subsequent statistical comparisons.

Results: Overall, the majority of participants reported moderate disease severity (65%) and concomitant self-reported low quality of life. The median CSF opening pressure was 18 (IQR 8) cmH2O, ranging from 11 to 29.5. Opening pressure stratification showed that 21 of the 34 cases (62%) had an OP measurement of <20 cmH2O (low-OP group) and 13 cases (38%) had an OP measurement of ≥20 cmH2O (high-OP group). The two OP groups did not differ significantly in baseline characteristics, including disease severity and quality of life. However, for certain radiological measurements, the high-OP group presented with measures reflecting a wider spinal canal, including a significantly larger foramen magnum diameter (33.9 mm), which was higher than the measures in the low-OP group (31.7 mm). Estimates of symptom relief 1-4 days post-LP were significantly higher among patients in the high-OP group (80%) than among those in the low-OP group (19%).

Conclusion: This study suggests that a proportion of patients with ME/CFS have elevated CSF opening pressures and may experience symptom relief following CSF subtraction. Our data indicate that some anatomical structures in the craniocervical area may be related to CSF pressure, although interpretation is challenging and merits further investigation.

Source: Jolley C, Bragée B, Soinne L, Huhmar H, Billing H, Bertilson B, Sjogren P. Cerebrospinal fluid opening pressure in relation to symptomatology and craniocervical anatomy in patients with myalgic encephalomyelitis/chronic fatigue syndrome. Front Med (Lausanne). 2026 Aug 4;13:1869714. doi: 10.3389/fmed.2026.1869714. PMID: 42614190; PMCID: PMC13481257. https://pmc.ncbi.nlm.nih.gov/articles/PMC13481257/ (Full text)

The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure

Abstract:

The etiopathogenesis of fibromyalgia (FM) and chronic fatigue syndrome (CFS) is not yet elucidated. Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is reflected in the hormonal disturbances found in FM and CFS. Some study groups have introduced a novel hypothesis that moderate or intermittent intracranial hypertension may be involved in the etiopathogenesis of FM and CFS.

In these conditions, hormonal disturbances may be caused by the mechanical effect of increased cerebrospinal fluid pressure, which hampers blood flow in the pituitary gland. Severe intracranial pressure may compress the pituitary gland, resulting in primary empty sella (ES), potentially leading to pituitary hormone deficiencies.

The aim of this narrative review was to explore whether similar hormonal changes and symptoms exist between primary ES and FM or CFS and to link them to cerebrospinal fluid pressure dysregulation. A thorough search of the PubMed and Web of Science databases and the reference lists of the included studies revealed that several clinical characteristics were more prevalent in primary ES, FM or CFS patients than in controls, including increased cerebrospinal fluid pressure, obesity, female sex, headaches and migraine, fatigue, visual disturbances (visual acuity and eye motility abnormalities), vestibulocochlear disturbances (vertigo and neurosensorial hearing loss), and bodily pain (radicular pain and small-fiber neuropathy).

Furthermore, challenge tests of the pituitary gland showed similar abnormalities in all three conditions: blunted adrenocorticotropic hormone, cortisol, growth hormone, luteinizing hormone, and thyroid stimulating hormone responses and an increased prolactin response. The findings of this narrative review provide further support for the hypothesis that moderately or intermittently increased cerebrospinal fluid pressure is involved in the pathogenesis of FM and CFS and should stimulate further research into the etiopathogenesis of these conditions.

Source: Hulens M, Dankaerts W, Rasschaert R, Bruyninckx F, De Mulder P, Bervoets C. The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure. J Pain Res. 2023;16:205-219
https://doi.org/10.2147/JPR.S394321 https://www.dovepress.com/the-link-between-empty-sella-syndrome-fibromyalgia-and-chronic-fatigue-peer-reviewed-fulltext-article-JPR (Full text)