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Ramsay definition
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=== Onset of the disease === The onset of the disease is similar to those described in the various recorded outbreaks. Thus it may be sudden and without apparent cause, as in cases where the first intimation of illness is an alarming attack of acute vertigo, but usually there is a history of infection of the upper respiratory tract or, occasionally, the gastrointestinal tract with nausea and/or vomiting. Instead of an uneventful recovery the patient is dogged by: ::*Persistent and profound fatigue accompanied by a medley of symptoms such as ::*Headache ::*Giddiness ::*Muscle pain, cramps, or twitchings ::*Muscle tenderness and weakness ::*Paraesthesiae [numbness or tingling in the extremeties] ::*Frequency of micturition [urination] ::*Blurred vision and/or diplopia [double vision] ::*Hyperacusis [sensitivity to noise sometimes alternating with deafness or normal hearing] ::*Tinnitus [constant sound in the ears], and a ::*General sense of feeling awful. :Some patients report the occurrence of fainting attacks relieved by a small meal or just eating a biscuit; these attacks were the result of hypoglycaemia :All cases run a low-grade pyrexia (fever), seldom exceeding 100Β°F (c. 38Β°C) and usually subsiding within a week. :A very thorough examination of the central nervous system should be made and this should be accompanied by a careful estimation of muscle power, especially in the limbs and neck. A search for enlarged lymph nodes should never be omitted. If muscle power is found to be satisfactory, a re-examination should be made after exercise; a walk of half a mile is sufficient, as very few ME cases can make more.<ref>[http://www.cfids-me.org/ramsay86.html#onset The Clinical Features of Myalgic Encephalomyelitis Melvin Ramsay, M.D., 1986 - Onset of the Disease - CFIDS-me.org]</ref>
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