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=== Blood flow === Several studies have ME/CFS patients have found evidence of reduced cerebral blood flow,<ref name="Natelson, 2017">{{Cite journal | last1 = Natelson | first1 =Benjamin | author-link1 = Benjamin Natelson | last2 = Mao | first2 = Xiangling | author-link2 = | last3 = Stegner | first3 = Aaron J | author-link3 = | last4 = Lange | first4 = Gudrun | author-link4 = Gudrun Lange | last5 = Vu | first5 = Diana| author-link5 = | last6 = Blate | first6 = Michelle| author-link6 = | last7 = Kang | first7 = Guoxin | author-link7 = | last8 = Soto | first8 = Eli | author-link8 = | last9 = Kapusuz | first9 = Tolga| author-link9 = | last10 = Shungu | first10 = Dikoma C | author-link10 = | title = Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity | journal = Journal of the Neurological Sciences | volume = 375 | issue = | page = 411-416 | date = 2017 | pmid = | pmc = PMC5393352 | url = https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5393352/ | doi = 10.1016/j.jns.2017.02.046}}</ref><ref name="Costa1995" /><ref name="Barnden2011" /><ref name="Biswal2011">{{Cite journal | last = Biswal | first = Bharat | last2 = Kunwar | first2 = Pratap | last3 = Natelson | first3 = Benjamin H. | date = 2011-02-15 | title = Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling | url =http://www.sciencedirect.com/science/article/pii/S0022510X10005666 | journal = Journal of the Neurological Sciences | volume = 301 | issue = 1 | pages = 9β11|doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name="Yoshiuchi2006">{{Cite journal | last = Yoshiuchi | first = Kazuhiro | last2 = Farkas | first2 = Jeffrey | last3 = Natelson | first3 = Benjamin H. | date = 2006 | title = Patients with chronic fatigue syndrome have reduced absolute cortical blood flow | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-097X.2006.00649.x | journal = Clinical Physiology and Functional Imaging|language=en | volume = 26 | issue = 2 | pages = 83β86|doi=10.1111/j.1475-097X.2006.00649.x|issn=1475-097X}}</ref><ref>{{Cite journal | last = Freedman | first = M. | last2 = Kirsh | first2 = J.C. | last3 = Gray | first3 = B. | last4 = Chung | first4 = D.G. | last5 = Abbey | first5 = S.E. | last6 = Salit | first6 = I.E. | last7 = Ichise | first7 = M. | date = Oct 1992 | title = Assessment of regional cerebral perfusion by 99Tcm-HMPAO SPECT in chronic fatigue syndrome. | url = http://europepmc.org/abstract/med/1491843 | journal = Nuclear medicine communications | volume = 13 | issue = 10 | pages = 767β772|issn=0143-3636|pmid=1491843}}</ref><ref>{{Cite journal | last = Chao | first = C.C. | last2 = Hu | first2 = S. | last3 = Pheley | first3 = A.M. | last4 = Schenck | first4 = C.H. | last5 = Grammith | first5 = F.C. | last6 = Sirr | first6 = S.A. | last7 = Peterson | first7 = P.K. | date = 1994-03-01 | title = Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients. | url = https://cvi.asm.org/content/1/2/222 | journal = Clinical and Diagnostic Laboratory Immunology|language=en | volume = 1 | issue = 2 | pages = 222β226|issn=1071-412X|pmid=7496949}}</ref><ref>{{Cite journal | last = Lange | first = Gudrun | last2 = Wang | first2 = Samuel | last3 = DeLuca | first3 = John | last4 = Natelson | first4 = Benjamin H. | date = 1998-09-28 | title = Neuroimaging in chronic fatigue syndrome | url =http://www.sciencedirect.com/science/article/pii/S0002934398001752 | journal = The American Journal of Medicine | volume = 105 | issue = 3, Supplement 1 | pages = 50Sβ53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> including the [[brainstem]]<ref name="Costa1995" /><ref name="Barnden2011" /> and cerebral cortex.<ref name="Yoshiuchi2006" /> A 1995 study found hypoperfusion (reduced blood flow) to the brainstem in patients with ME/CFS.<ref name="Costa1995">{{Cite journal | last = Costa | first = D.C. | last2 = Tannock | first2 = C. | last3 = Brostoff | first3 = J. | date = Nov 1995 | title = Brainstem perfusion is impaired in chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/8542261 | journal = QJM: monthly journal of the Association of Physicians | volume = 88 | issue = 11 | pages = 767β773|issn=1460-2725|pmid=8542261}}</ref> In 2011, a study of brain involvement in CFS found "aΒ strong correlation" between brainstem gray matter volume and pulse pressure, "suggesting impaired cerebrovascular autoregulation."<ref name="Barnden2011">{{Cite journal | last = Barnden | first = Leighton R. | last2 = Crouch | first2 = Benjamin | last3 = Kwiatek | first3 = Richard | last4 = Burnet | first4 = Richard | last5 = Mernone | first5 = Anacleto | last6 = Chryssidis | first6 = Steve | last7 = Scroop | first7 = Garry | last8 = Fante | first8 = Peter Del | date = 2011 | title = A brain MRI study of chronic fatigue syndrome: evidence of brainstem dysfunction and altered homeostasis |url =https://onlinelibrary.wiley.com/doi/abs/10.1002/nbm.1692 | journal = NMR in Biomedicine|language=en | volume = 24 | issue = 10 | pages = 1302β1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc=4369126|pmid=21560176}}</ref> A study of 429 ME/CFS patients by found that 90% ME/CFS patients had reduced cerebral blood flow with a head-up tilt test, even in the absence of [[Postural orthostatic tachycardia syndrome]] or [[Orthostatic hypotension]].<ref>{{Citation | title = CMRC Conference 2017 day 1- Prof Dr Frans Visser |url =https://www.youtube.com/watch?v=IWRA23D_MUg|language=en | access-date = 2019-09-03}}</ref><ref>{{Cite journal | last = van Campen | first = C. (Linda) M.C. | last2 = Verheugt | first2 = Freek W.A. | last3 = Rowe | first3 = Peter C. | last4 = Visser | first4 = Frans C. | date = 2020-01-01 | title = Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography | url = http://www.sciencedirect.com/science/article/pii/S2467981X20300044 | journal = Clinical Neurophysiology Practice|language=en | volume = 5 | pages = 50β58|doi=10.1016/j.cnp.2020.01.003|issn=2467-981X | issue = |pmc=|pmid=|quote= | author-link = Linda van Campen | author-link2 = |access-date= | author-link3 = Peter Rowe | author-link4 = Frans Visser | author-link5 = |via=}}</ref>
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