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Ramsay definition
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=== Disease in chronic state === Once the syndrome is fully established the patient presents a multiplicity of symptoms which can most conveniently be described in three groups. #Muscle phenomena :::*[Fatiguability]: Muscle fatigability, whereby, even after a minor degree of physical effort, three, four or five days, or longer, elapse before full muscle power is restored and constitutes the sheet anchor of diagnosis. Without it I would be unwilling to diagnose a patient as suffering from ME, but it is most important to stress the fact that cases of ME or mild or even moderate severity may have normal muscle power in a remission. In such cases, tests for muscle power should be repeated after exercise. :::*[Pain:] In severe cases of ME, muscle spasms and twitchings are a prominent feature and give rise to swollen bands of tissue which are acutely tender. In less severe cases, muscle tenderness may not be so readily elicited but careful palpation of the trapezii and gastrocnemii (the muscle groups most commonly involved) with the tip of the forefinger should enable the examiner to detect minute foci or exquisite tenderness. :::*[Clumsiness:] In the aftermath of the disease patients frequently fumble with relatively simple manoevres such as turning a key in a lock or taking the cork of a bottle. *Circulatory impairment. Most cases of ME complain of ::*Cold extremities and ::*Hypersensitivity to climactic change . . . ::*Ashen-grey facial pallor, some twenty or thirty minutes before the Patient complains of feeling ill *Cerebral dysfunction :*The cardinal features: ::*Impairment of memory ::*Impairment of powers of concentration and ::*Emotional lability *[Other] common deviations from normal cerebral function: ::*Failure to recall recent or past events, ::*Difficulty in completing a line of thought . . . ::*Becoming tongue-tied in the middle of a sentence, and a ::*Strong inclination to use wrong words, saying door when they mean table or hot when they mean cold . . . ::*Complete inability to comprehend a paragraph even after re-reading it ::*Bouts of uncontrollable weeping . . . ::*Alterations of sleep rhythm or vivid dreams, or both . . . [Accompanying] features [that] can only be attributed to involvement of the Autonomic nervous system: :::*Frequency of micturition (urination) :::*Hyperacusis (hypersensitivity to noise) :::*Episodic sweating :::*Orthostatic tachycardia . . . Variability and fluctuation of both symptoms and physical findings in the course of a day is a constant feature in the clinical picture of myalgic encephalomyelitis. An alarming tendency to become chronic. [Added in the 2nd edition, 1988]<ref>[http://www.cfids-me.org/ramsay86.html#chronic The Clinical Features of Myalgic Encephalomyelitis Melvin Ramsay, M.D., 1986 - Disease in the chronic state - CFIDS-me.org]</ref>
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