Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome

Lange, Gudrun; DeLuca, John; Maldjian, Joseph A.; Lee, Huey Jen; Tiersky, Lana A.; Natelson, Benjamin H.

doi:10.1016/s0022-510x(99)00243-9

Cited by 145 publications

(97 citation statements)

References 18 publications

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“…Specifically, the subgroup of patients with no history of having had a psychiatric disorder was the group with the most brain MRI abnormalities (11) and the most abnormalities on neuropsychological testing (3). We interpreted those data as suggesting the presence of encephalopathy in this subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, we reported that patients with a sudden illness onset (4) as well as those with no history of psychiatric diagnosis (3) had more evidence of cognitive dysfunction than other CFS groups. Moreover, we showed that CFS patients with no history of psychiatric diagnosis had more abnormalities on brain magnetic resonance imaging (MRI) (11) and that those patients with MRI abnormalities had poorer physical function than those without these abnormalities (2). These results suggested that the abnormalities were not merely epiphenomena of CFS but instead contributed to the patients' symptom burden.…”

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confidence: 89%

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Spinal Fluid Abnormalities in Patients with Chronic Fatigue Syndrome

Natelson¹,

Weaver²,

Tseng

et al. 2005

Clin Vaccine Immunol

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Arguments exist as to the cause of chronic fatigue syndrome (CFS). Some think that it is an example of symptom amplification indicative of functional or psychogenic illness, while our group thinks that some CFS patients may have brain dysfunction. To further pursue our encephalopathy hypothesis, we did spinal taps on 31 women and 13 men fulfilling the 1994 case definition for CFS and on 8 women and 5 men serving as healthy controls. Our outcome measures were white blood cell count, protein concentration in spinal fluid, and cytokines detectable in spinal fluid. We found that significantly more CFS patients had elevations in either protein levels or number of cells than healthy controls (30 versus 0%), and 13 CFS patients had protein levels and cell numbers that were higher than laboratory norms; patients with abnormal fluid had a lower rate of having comorbid depression than those with normal fluid. In addition, of the 11 cytokines detectable in spinal fluid, (i) levels of granulocyte-macrophage colony-stimulating factor were lower in patients than controls, (ii) levels of interleukin-8 (IL-8) were higher in patients with sudden, influenza-like onset than in patients with gradual onset or in controls, and (iii) IL-10 levels were higher in the patients with abnormal spinal fluids than in those with normal fluid or controls. The results support two hypotheses: that some CFS patients have a neurological abnormality that may contribute to the clinical picture of the illness and that immune dysregulation within the central nervous system may be involved in this process.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 89%

Spinal Fluid Abnormalities in Patients with Chronic Fatigue Syndrome

Natelson¹,

Weaver²,

Tseng

et al. 2005

Clin Vaccine Immunol

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“…Several symptoms seen in chronic fatigue syndrome patients-including fatigue impaired concentration, memory and attention and headache-suggest that the central nervous system may be involved in the etiology of the syndrome. Infact such studies showed central nervous system (CNS) link to chronic fatigue syndrome by means of structural and functional neuro-imaging, cognitive testing, neuropeptide assays, and autonomic assessment 14,15 . Neuropsychiatric impairements include the poorer performance of subjects with chronic fatigue syndrome on complex attention and information related tasks .…”

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confidence: 99%

Chronic fatigue syndrome revisited

Neki

2016

Bangladesh J Med Sci

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Abstract:Chronic fatigue syndrome (CFS) is a common and disabling problem; although most likely of biopsychosocial origin. The nature of the pathophysiological components remains unclear. It is an illness characterized by persistent and relapsing fatigue, often accompanied by numerous symptoms involving various body systems. The etiology of CFS remains unclear. Celiac disease can present with neurological symptoms in the absence of gastrointestinal symptoms; therefore, celiac disease should be included in the differential diagnosis of CFS.

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“…Neuroimaging research in chronic fatigue has found white matter lesions in the frontal area on MRI and cerebral hypoperfusion in the brain stem on SPECT [29], although hypoperfusion has been found in several brain regions, and the findings varied across research centers. Patients with fatigue and without comorbid psychopathology have been found to have more white matter lesions on MRI [30], and more brain stem hypoperfusion [31]. Fischler et al found positive associations between frontal blood flow, objective and subjective measure of cognitive function, and depressive symptoms [32].…”

Section: Discussionmentioning

confidence: 99%

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Raszeja‐Wyszomirska¹,

Zorga²,

Kotulski³

et al. 2017

IJCEMS

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Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium 99m labeled exametazime ( 99m Tc -HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.

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Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome

Cited by 145 publications

References 18 publications

Spinal Fluid Abnormalities in Patients with Chronic Fatigue Syndrome

Spinal Fluid Abnormalities in Patients with Chronic Fatigue Syndrome

Chronic fatigue syndrome revisited

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

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Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome

Cited by 145 publications

References 18 publications

Spinal Fluid Abnormalities in Patients with Chronic Fatigue Syndrome

Spinal Fluid Abnormalities in Patients with Chronic Fatigue Syndrome

Chronic fatigue syndrome  revisited

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

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Chronic fatigue syndrome revisited