CFS/ME, CFS Leak and IIH induced by IJV compression

Here comes a recent (2023) study about CFS/ME, CSF Leak and IJVS connection.

Life changing response to successive surgical interventions on cranial venous outflow: A case report on chronic fatigue syndrome

J. Nicholas P. Higgins1* Patrick R. Axon2 Andrew M. L. Lever3,4

  • 1Department of Radiology, Addenbrooke’s Hospital, Cambridge, United Kingdom
  • 2Skull Base Unit, Addenbrooke’s Hospital, Cambridge, United Kingdom
  • 3Department of Medicine, University of Cambridge, Cambridge, United Kingdom
  • 4Deparment of Infectious Diseases, Addenbrooke’s Hospital, Cambridge, United Kingdom

Recognition of similarities between chronic fatigue syndrome and idiopathic intracranial hypertension (IIH) has raised suggestions that they might be connected, with chronic fatigue syndrome representing a mild version of IIH, sharing many of its symptoms, but without the signature features of elevated intracranial pressure that characterize the complete syndrome. A further development of this idea factors in the effects of a cerebrospinal fluid leak, a known complication of IIH, to explain cases where symptoms seem out of proportion to the apparent physiological disturbance. Cranial venous outflow obstruction has been proposed as the pathological substrate. We describe a patient with multiple symptoms, including headache and disabling fatigue, in which this model guided investigation and treatment. Specifically, CT and catheter venography identified focal narrowings of both jugular and the left brachiocephalic veins. Treatment of brachiocephalic obstruction was not feasible. However, in separate surgical procedures, relief of jugular venous obstruction produced incremental and significant clinical improvements which have proven durable over the length of follow-up. We suggest that investigating chronic fatigue syndrome under this model might not only bring benefit to individual patients but also will provide new insights into IIH and its relationship with spontaneous intracranial hypotension.

Study Link :


This is a really good case report. It’s also really good to read that the patient saw small gradual improvements over the following weeks after surgery.

I’m still really curious about how they decide how much of the VA to expose when shaving back the c1, in these images it looks like the left artery is completely exposed on the lateral side.


Yeah, it depends. I think some surgeons shave all the way to VA and some are conservative. My Surgeon was extremely careful so I think he only removed half of the compressing bone in order to leave some to protect the VA. The best I can hope is partial compression as he indicated to me that he left some bone to protect the VA.


Thanks for paper. Shame mr higgins is not working now due to health issues. Based on my experience I do not think too aggressive removal is C1 is advisable. Heard it can cause instability & other issues. Of course it’s important enough is reduced to relieve any compression. D


Thanks for posting this @KoolDude …as @elijah says, encouraging that improvements were noticed over time.