Higgins, J Nicholas P, Axon, Patrick R, Lever, Andrew M L · Frontiers in neurology · 2023 · DOI
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.
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.
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.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Higgins, J Nicholas P, Axon, Patrick R, & Lever, Andrew M L (2023). Life changing response to successive surgical interventions on cranial venous outflow: A case report on chronic fatigue syndrome.. Frontiers in neurology. https://doi.org/10.3389/fneur.2023.1127702
BibTeX
@article{mecfsatlas-higgins-2023-life-changing,
author = {Higgins, J Nicholas P and Axon, Patrick R and Lever, Andrew M L},
title = {Life changing response to successive surgical interventions on cranial venous outflow: A case report on chronic fatigue syndrome.},
journal = {Frontiers in neurology},
year = {2023},
doi = {10.3389/fneur.2023.1127702},
note = {PubMed: 37064208},
url = {https://www.mecfsatlas.com/evidence/higgins-2023-life-changing},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/higgins-2023-life-changing
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