Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling

Abstract

Background Chronic fatigue syndrome is diagnosed by a set of clinical criteria and therefore is probably heterogeneous. Earlier reports tested the hypothesis that the syndrome had a neurological substrate by doing studies of cerebral blood flow (CBF) but with discrepant results. One possible reason for the discrepancy was that relative CBF was assessed. We found reduced CBF in an earlier study of absolute CBF using xenon-CT. The purpose of this study was to use a second method of assessing CBF and to look within the study group for heterogeneity of responses. Method Eleven CFS patients and 10 age matched healthy controls underwent neuro-imaging using arterial spin labeling to determine their regional and global absolute CBF. A template was constructed based on the control data, and individual patient montages were compared on a case by case basis to determine if differences in regions of interest occurred. Results The patients as a group had significantly lower global CBF than the controls. The reduction in CBF occurred across nearly every region assessed. Nine of the 11 patients showed these reductions compared to the average control data, while two patients showed actual increases relative to the controls. Conclusion The data extend our earlier observation that CFS patients as a group have broad decreases in CBF compared to healthy controls. However, as expected, the effect was not homogeneous in that 2 of the 11 patients studied showed actual increases in CBF relative to controls.

Role of Infection and Neurologic Dysfunction in Chronic Fatigue Syndrome

“…[70][71][72][73][74][75][76][77][78][79][80] A consensus panel of autonomic experts concluded that the literature provided strong evidence for exaggerated venous pooling, diminished red cell mass, reduced plasma volume, disordered sympathetic activity, impaired baroreflex function, and reduced cerebral perfusion. 80,81 The most frequently observed disorders on autonomic testing are postural orthostatic tachycardia syndrome, neurally mediated hypotension, and heart rate variability during head-up tilt testing. Investigators have reported a strong correlation between symptoms of autonomic dysfunction, as assessed by the Composite Autonomic Symptom Scale (COMPASS), and fatigue, as assessed by a validated instrument, the Fatigue Impact Scale.…”

T. Egeland og medarbeidere svarer:

“…Billeddiagnostiske og nevropsykologiske tester viser avvikende funn i sentralnervesystemet hos pasienter med CFS/ME (37)(38)(39)(40)(41)(42)(43) . «Sentral sensitisering» (utvikling av hypersensitivitet for ulike stimuli i sentralnervesystemet), kan vaere en mekanisme ved CFS/ME (44)(45)(46) .…”

Could cadmium be responsible for some of the neurological signs and symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…Cerebral blood flow is decreased in most, but not all, ME/CFS patients [30], and the cortical blood flow appears to be most affected [31]. The reduction of cerebral blood flow led the Authors to hypothesize that low global cerebral flow was associated with abnormal brain neuroimaging results and objective evidence of brain dysfunction in the form of reduced cognitive testing scores [30].…”

“…Cerebral cortex blood flow could be measured with functional magnetic resonance imaging as in [30] and/or also with the transcranial sonography technique described above. In fact, with the type of setting described and using Doppler technique, we could also observe arterial vascularisation of the meninges and of cortex of the temporal lobe and pulsating arteries of about one mm diameter could be easily visualized (Fig.…”

“…The use of transcranial sonography of the temporal lobe could prove easier and certainly less expensive than functional magnetic resonance imaging and thus become part of routine examination of ME/CFS patients. Since reduction of cerebral blood flow in ME/CFS patients occurs across nearly every region assessed by functional magnetic resonance imaging [30] or by xenon-computed tomography [31], the temporal lobe could represent an easily accessible region of the human brain to be studied by transcranial sonography.…”