MEpedia - User contributions [en]

Vertebral column

2020-12-04T21:32:24Z

Spoonface:Linking to main page on tarlov cysts

Tarlov cyst

2020-12-04T21:31:23Z

Spoonface:Created page

Perineural cysts or Tarlov cysts (TCs) are nerve root dilations resulting from pathologically increased cerebrospinal fluid pressure.

A study of 197 ME/CFS patients found that the prevalence of Tarlov cysts was three times higher in ME/CFS patients than the general population, at 39%.<ref>{{Cite journal|last=Hulens|first=Mieke|last2=Bruyninckx|first2=Frans|last3=Dankaerts|first3=Wim|last4=Rasschaert|first4=Ricky|last5=De Mulder|first5=Peter|last6=Stalmans|first6=Ingeborg|last7=Vansant|first7=Greet|last8=Bervoets|first8=Chris|date=2020-12-01|title=High Prevalence of Perineural Cysts in Patients with Fibromyalgia and Chronic Fatigue Syndrome|url=https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaa410/6015822|journal=Pain Medicine|language=en|pages=pnaa410|doi=10.1093/pm/pnaa410|issn=1526-2375}}</ref>

Tarlov cyst patients often complain about widespread pain and fatigue.

The study's authors conclude:<blockquote>This observation supports the hypothesis that STCs, FM, and CFS may share the same pathophysiological mechanism, i.e., moderately increased cerebrospinal fluid pressure, causing irritation of neurons and axons in dorsal root ganglia</blockquote>

Vertebral column

2020-12-04T21:28:35Z

Spoonface:Moved from brain section

The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs.[1] The vertebral column houses the spinal canal, a cavity that encloses and protects the spinal cord.

== Spinal pathologies ==

=== Chiari I malformation ===
{{Main article|page_name=Chiari malformation}}

=== Craniocervical instability ===
{{Main article|page_name=Craniocervical instability}}

=== Atlantoaxial instability ===
{{Main article|page_name=Atlantoaxial instability}}

=== Cervical stenosis ===
{{Main|page_name=Cervical spinal stenosis}}

=== Tethered cord syndrome ===
{{Main article|page_name=Tethered cord syndrome}}

=== Tarlov cysts ===
Perineural cysts or Tarlov cysts (TCs) are nerve root dilations resulting from pathologically increased cerebrospinal fluid pressure.

A study of 197 ME/CFS patients found that the prevalence of Tarlov cysts was three times higher in ME/CFS patients than the general population, at 39%.<ref>{{Cite journal|last=Hulens|first=Mieke|last2=Bruyninckx|first2=Frans|last3=Dankaerts|first3=Wim|last4=Rasschaert|first4=Ricky|last5=De Mulder|first5=Peter|last6=Stalmans|first6=Ingeborg|last7=Vansant|first7=Greet|last8=Bervoets|first8=Chris|date=2020-12-01|title=High Prevalence of Perineural Cysts in Patients with Fibromyalgia and Chronic Fatigue Syndrome|url=https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaa410/6015822|journal=Pain Medicine|language=en|pages=pnaa410|doi=10.1093/pm/pnaa410|issn=1526-2375}}</ref>

Tarlov cyst patients often complain about widespread pain and fatigue.

The study's authors conclude:<blockquote>This observation supports the hypothesis that STCs, FM, and CFS may share the same pathophysiological mechanism, i.e., moderately increased cerebrospinal fluid pressure, causing irritation of neurons and axons in dorsal root ganglia</blockquote>
== Association with syndromes ==

=== ME/CFS ===
Craniocervical instability

Cervical stenosis

Tarlov cysts

=== Fibromyalgia ===
Chiari malformation

=== Ehlers-Danlos Syndrome ===
Several pathologies of the spine have been associated with [[Ehlers-Danlos Syndrome]]. (Link to and reference Henderson et al)

== Related ==
* [[Brain]]

== See also ==

== References ==

Brain

2020-12-04T21:27:11Z

Spoonface:Brain fog day, appropriately. Moving content to correct page.

[[File:Brain diagram CNS.jpg|400px|thumb|Diagram of Brain<ref>{{Cite web|url=https://cnx.org/contents/GFy_h8cu@11.5:JOhgnBan@4/The-Central-Nervous-System|title=The Central Nervous System|last=|first=|date=29 September 2018|website=OpenStax Biology|archive-url=|archive-date=|dead-url=|access-date=29 September 2018}}</ref> License: CC-BY-4.0|alt=Diagram of brain showing Corpus callosum, cerebral cortex, cerebellum, brainsteam, amydala, thalamus, basal ganglia]]
The '''brain''' is an organ that serves as the center of the [[nervous system]] in all vertebrate and most invertebrate animals. The brain is located in the head, usually close to the sensory organs for senses such as vision. It is divided into three parts: the [[brainstem]], cerebellum and cerebrum. The brain and spinal cord make up the [[central nervous system]] (CNS).

The brain and [[spinal cord]] have their own [[immune system]].<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2019/02/190219132853.htm|title=Scientists create new map of brain's immune system|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Feb 19, 2019|website=ScienceDaily|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref> Tissue-resident macrophages, known as [[microglia]], are a part of that immune system.<ref>{{Cite web|title=Brain immune system is key to recovery from motor neuron degeneration: Results in study point to new approaches for ALS therapy|url=https://www.sciencedaily.com/releases/2018/02/180220143439.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Feb 20, 2018|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>

The brain also has its own [[lymphatic system]] which links directly to the blood-borne [[immune system]].<ref>{{Cite web|url=https://www.scientificamerican.com/article/important-link-between-the-brain-and-immune-system-found/|title=Important Link between the Brain and Immune System Found|last=Stetka|first=Bret|authorlink=|last2=|first2=|authorlink2=|date=Jul 21, 2015|website=Scientific American|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref>

Injury to the brain or [[spinal cord]], such as those caused by stroke or [[trauma]], result in a considerable weakening of the immune system.<ref>{{Cite web|title=An interconnection between the nervous and immune system: Neuroendocrine reflex triggers infections|url=https://www.sciencedaily.com/releases/2017/09/170919102530.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Sep 29, 2017|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>
==ME/CFS ==

<div role="note" class="hatnote navigation-not-searchable">''Main article: [[Neurology of ME/CFS]]''</div>

=== Anatomical changes ===
Significant changes in white and gray matter volumes have frequently been found in patients with ME/CFS but no consistent pattern has been found.<ref name="Shan2016" /><ref name="JaimeS20160505" /><ref name="Goldman20141028">{{citation
| last1 = Goldman | first1 = Bruce | authorlink1 =
| title = Study finds brain abnormalities in chronic fatigue patients
| journal = Stanford Medicine News Center
| date = 2014-10-28
| url = http://med.stanford.edu/news/all-news/2014/10/study-finds-brain-abnormalities-in-chronic-fatigue-patients.html
}}</ref><ref name="Zeineh2014">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref><ref name="Puri, 2012">{{Citation
| last1 = Puri | first1 = BK | authorlink1 = Basant Puri
| last2 = Jakeman | first2 =PM | authorlink2 =
| last3 = Agour | first3 = M | authorlink3 =
| last4 = Gunatilake | first4 = KDR | authorlink4 =
| last5 = Fernando | first5 = KAC | authorlink5 =
| last6 = Gurusinghe | first6 = AI | authorlink6 =
| last7 = Treasaden | first7 = IH | authorlink7 =
| last8 = Waldman | first8 = AD | authorlink8 =
| last9 = Gishen | first9 = P | authorlink9 =
| title = Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study
| journal = British Journal of Radiology | volume = 85 | issue = 1015 | page = e270-3
| date = 2012
| pmid =
| doi = 10.1259/bjr/93889091
}}</ref>

{| class="wikitable"
!Year
!Authors
!N
!Criteria
!Findings
!Ref
|-
|2004
|Okada, et al
|16
|
|Reduced gray-matter volume in the bilateral prefrontal cortex. Volume reduction in the right prefrontal cortex correlated with fatigue severity.
|<ref>{{Cite journal|last=Okada|first=Tomohisa|last2=Tanaka|first2=Masaaki|last3=Kuratsune|first3=Hirohiko|last4=Watanabe|first4=Yasuyoshi|last5=Sadato|first5=Norihiro|date=2004-10-04|title=Mechanisms underlying fatigue: a voxel-based morphometric study of chronic fatigue syndrome|url=https://doi.org/10.1186/1471-2377-4-14|journal=BMC Neurology|volume=4|issue=1|pages=14|doi=10.1186/1471-2377-4-14|issn=1471-2377|pmc=PMC524491|pmid=15461817}}</ref>
|-
|2016
|Shan, et al
|
|Fukuda & CCC
|Decreases in [[white matter]], [[gray matter]] and blood volume deficits
|<ref name="Shan20162">{{citation
| last1 = Shan | first1 = ZY | authorlink1 = Zack Shan
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
|-
|2012
|Basant Puri, et al
|
|
|Reduced grey matter volume in the occipital lobes, the right angular gyrus and the posterior division of the left parahippocampal gyrus.
|<ref name="Puri, 2012" />
|-
|2014
|Zeineh, et al
|
|
|Diminished white matter, white matter abnormalities in the right hemisphere.
|<ref name="Zeineh2014" />
|}

=== Blood flow ===
Several studies have ME/CFS patients have found evidence of reduced cerebral blood flow,<ref name="Natelson, 2017" /><ref name=":3" /><ref name=":10" /><ref>{{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=9–11|doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name=":11">{{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=83–86|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=767–772|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=222–226|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=50S–53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> including the [[brainstem]]<ref name=":3" /><ref name=":10" /> and cerebral cortex.<ref name=":11" />

A 1995 study found hypoperfusion (reduced blood flow) to the brainstem in patients with ME/CFS.<ref name=":3">{{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=767–773|issn=1460-2725|pmid=8542261}}</ref> In 2011, a study of brain involvement in CFS found "a strong correlation" between brainstem gray matter volume and pulse pressure, "suggesting impaired cerebrovascular autoregulation."<ref name=":10">{{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=1302–1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc=PMC4369126|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=50–58|doi=10.1016/j.cnp.2020.01.003|issn=2467-981X}}</ref>

=== Metabolism ===
A 2003 study of [[Brain|cerebral]] [[glucose]] metabolism in 26 patients with [[chronic fatigue syndrome]] via 18-fluorodeoxyglucose positron emission tomography (FDG-PET) found evidence of hypometabolism (reduced glucose consumption) in approximately half of patients.<ref>{{Cite journal|title=Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome|url=https://jnnp.bmj.com/content/74/7/922|journal=Journal of Neurology, Neurosurgery & Psychiatry|date=2003-07-01|issn=0022-3050|pmid=12810781|pages=922–928|volume=74|issue=7|doi=10.1136/jnnp.74.7.922|language=en|first=P.|last=Bartenstein|first2=U. T.|last2=Egle|first3=M.|last3=Schreckenberger|first4=J.|last4=Hardt|first5=W. A.|last5=Nix|first6=T.|last6=Siessmeier}}</ref> A 1998 PET study also found evidence of reduced metabolism in 18 patients.<ref>{{Cite journal|last=Tirelli|first=Umberto|last2=Chierichetti|first2=Franca|last3=Tavio|first3=Marcello|last4=Simonelli|first4=Cecilia|last5=Bianchin|first5=Gianluigi|last6=Zanco|first6=Pierluigi|last7=Ferlin|first7=Giorgio|date=1998-09-28|title=Brain positron emission tomography (PET) in chronic fatigue syndrome: preliminary data|url=http://www.sciencedirect.com/science/article/pii/S000293439800179X|journal=The American Journal of Medicine|volume=105|issue=3, Supplement 1|pages=54S–58S|doi=10.1016/S0002-9343(98)00179-X|issn=0002-9343}}</ref>

Patients with ME/CFS have also been found to have lower brain glutathione<ref name="Natelson, 2017" /> and higher brain ventricular lactate.<ref name="Natelson, 2017" />

Abnormal distribution of acetyl-L-carnitine uptake, which is one of the biochemical markers of chronic fatigue syndrome, in the prefrontal cortex.{{Citation needed|reason=clarify}}

=== Inflammation ===
{{Main article|page_name=Neuroinflammation}}

Whole-brain MRS markers of neuroinflammation have been found in ME/CFS.<ref name=":02">{{Cite web|url=https://link.springer.com/epdf/10.1007/s11682-018-0029-4?|title=Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy|last=|first=|authorlink=Christina Mueller|last2=|first2=|authorlink2=Joanne Lin|date=2019|website=link.springer.com|doi=10.1007/s11682-018-0029-4|archive-url=|archive-date=|dead-url=|access-date=2019-01-17|authorlink3=Sulaiman Sheriff|authorlink4=Andrew Maudsley|authorlink5=Jarred Younger}}</ref> fMRI images document neuroinflammation.<ref name="Zeineh20143">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref>

In 2014, A Japanese [[positron emission tomography]] (PET) study looked at [[neuroinflammation]] in nine patients with ME/CFS and ten controls. They measured a protein expressed by activated [[microglia]], and found that values in the [[cingulate cortex]], [[hippocampus]], [[amygdala]], [[thalamus]], [[midbrain]], and [[pons]] were 45%–199% higher in ME/CFS patients than in healthy controls. The values in the amygdala, thalamus, and midbrain positively correlated with cognitive impairment score, the values in the cingulate cortex and thalamus positively correlated with pain score, and the value in the hippocampus positively correlated with depression score.<ref name="Nakatomi2014">{{citation
| last1 = Nakatomi | first1 = Yasuhito | authorlink1 =
| last2 = Mizuno | first2 = Kei | authorlink2 =
| last3 = Ishii | first3 = Akira | authorlink3 =
| last4 = Wada | first4 = Yasuhiro | authorlink4 =
| last5 = Tanaka | first5 = Masaaki | authorlink5 =
| last6 = Tazawa | first6 = Shusaku | authorlink6 =
| last7 = Onoe | first7 = Kayo | authorlink7 =
| last8 = Fukuda | first8 = Sanae | authorlink8 =
| last9 = Kawabe | first9 = Joji | authorlink9 =
| last10 = Takahashi | first10= Kazuhiro | authorlink10=
| last11 = Kataoka | first11= Yosky | authorlink11=
| last12 = Shiomi | first12= Susumu | authorlink12=
| last13 = Yamaguti | first13= Kouzi | authorlink13=
| last14 = Inaba | first14= Masaaki | authorlink14=
| last15 = Kuratsune | first15= Hirohiko | authorlink15=
| last16 = Watanabe | first16= Yasuyoshi | authorlink16= Yasuyoshi Watanabe
| display-authors = 3
| title = Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An ¹¹C-(R)-PK11195 PET Study
| journal = Journal of Nuclear Medicine | volume = 2014 Jun;55(6) | page = 945-50
| date = 2014-03-24
| pmid = 24665088 | doi = 10.2967/jnumed.113.131045
| url = http://jnm.snmjournals.org/content/55/6/945.long
}}</ref><ref name="Tuller20141124NYT">{{citation
| last1 = Tuller | first1 = David | authorlink1 = David Tuller
| title = Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder
| journal = NY Times
| date = 2014-11-24
| url = http://well.blogs.nytimes.com/2014/11/24/brains-of-people-with-chronic-fatigue-syndrome-offer-clues-about-disorder/?_r=0
}}</ref>

2019, [[Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy (2019) Mueller, et al|Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy]], Mueller, et al.<ref name=":022" /><blockquote>This study is the first to investigate whole-brain MRS markers of neuroinflammation in ME/CFS. We report [[metabolite]] and temperature abnormalities in ME/CFS patients in widely distributed brain areas, suggesting ME/CFS is driven by diffuse pathophysiological processes affecting the whole brain, rather than regionally limited, which is consistent with the heterogeneity of its clinical symptoms. Our findings add support to the hypothesis that ME/CFS is the result of chronic, low-level neuroinflammation. While the whole-brain results are preliminary, we note that they largely agree with past publications that use MRS in ME/CFS. These results should be replicated in future studies with larger samples to further establish the profile of pathophysiological abnormalities in the brains of ME/CFS patients. Ultimately, the development of sensitive MRI markers of ME/CFS could supplement clinical tests to help guide treatment decisions.<ref name=":022" /></blockquote>

Several neurochemicals have been studied in relation to ME patients. Myo-inositol is thought to be involved in astrocyte function (Albrecht et al. 2016) and trended to be higher in ME patients compared to controls.<ref name=":5">{{Cite journal|last=Brooks|first=J. C.|last2=Roberts|first2=N.|last3=Whitehouse|first3=G.|last4=Majeed|first4=T.|date=Nov 2000|title=Proton magnetic resonance spectroscopy and morphometry of the hippocampus in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11144799|journal=The British Journal of Radiology|volume=73|issue=875|pages=1206–1208|doi=10.1259/bjr.73.875.11144799|issn=0007-1285|pmid=11144799}}</ref>

N-acetylacetate (NAA) shows neuron density, which has been found in other neurological disorders<ref name=":2">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Granziera|first2=Cristina|last3=Hooker|first3=Jacob M.|last4=Loggia|first4=Marco L.|date=2016-04-20|title=In Vivo Imaging of Human Neuroinflammation|url=https://www.ncbi.nlm.nih.gov/pubmed/26985861|journal=ACS chemical neuroscience|volume=7|issue=4|pages=470–483|doi=10.1021/acschemneuro.6b00056|issn=1948-7193|pmc=5433433|pmid=26985861}}</ref>and has been shown to be lower in ME patients,<ref name=":4">{{Cite journal|last=Chaudhuri|first=A.|last2=Condon|first2=B. R.|last3=Gow|first3=J. W.|last4=Brennan|first4=D.|last5=Hadley|first5=D. M.|date=2003-02-10|title=Proton magnetic resonance spectroscopy of basal ganglia in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12598734|journal=Neuroreport|volume=14|issue=2|pages=225–228|doi=10.1097/01.wnr.0000054960.21656.64|issn=0959-4965|pmid=12598734}}</ref><ref name=":5" />but this was not found in all studies.<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=Nov 2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861}}</ref><ref name=":6">{{Cite journal|last=Tomoda|first=A.|last2=Miike|first2=T.|last3=Yamada|first3=E.|last4=Honda|first4=H.|last5=Moroi|first5=T.|last6=Ogawa|first6=M.|last7=Ohtani|first7=Y.|last8=Morishita|first8=S.|date=Jan 2000|title=Chronic fatigue syndrome in childhood|url=https://www.ncbi.nlm.nih.gov/pubmed/10761837|journal=Brain & Development|volume=22|issue=1|pages=60–64|issn=0387-7604|pmid=10761837}}</ref>

[[Choline]] is linked to activation of glia, loss of energy and expression of macrophages in the brain<ref name=":2" />and has been shown to change compared to controls.<ref name=":4" /><ref name=":5" /><ref name=":6" /><ref>{{Cite journal|last=Puri|first=B. K.|last2=Agour|first2=M.|last3=Gunatilake|first3=K. D. R.|last4=Fernando|first4=K. a. C.|last5=Gurusinghe|first5=A. I.|last6=Treasaden|first6=I. H.|date=Nov 2009|title=An in vivo proton neurospectroscopy study of cerebral oxidative stress in myalgic encephalomyelitis (chronic fatigue syndrome)|url=https://www.ncbi.nlm.nih.gov/pubmed/19906518|journal=Prostaglandins, Leukotrienes, and Essential Fatty Acids|volume=81|issue=5-6|pages=303–305|doi=10.1016/j.plefa.2009.10.002|issn=1532-2823|pmid=19906518}}</ref>

Lactate increases when more energy is being expended and has been shown to be higher than controls,<ref name=":7">{{Cite journal|last=Mathew|first=Sanjay J.|last2=Mao|first2=Xiangling|last3=Keegan|first3=Kathryn A.|last4=Levine|first4=Susan M.|last5=Smith|first5=Eric L. P.|last6=Heier|first6=Linda A.|last7=Otcheretko|first7=Viktor|last8=Coplan|first8=Jeremy D.|last9=Shungu|first9=Dikoma C.|date=Apr 2009|title=Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: an in vivo 3.0 T (1)H MRS imaging study|url=https://www.ncbi.nlm.nih.gov/pubmed/18942064|journal=NMR in biomedicine|volume=22|issue=3|pages=251–258|doi=10.1002/nbm.1315|issn=0952-3480|pmid=18942064}}</ref><ref>{{Cite journal|last=Shungu|first=Dikoma C.|last2=Weiduschat|first2=Nora|last3=Murrough|first3=James W.|last4=Mao|first4=Xiangling|last5=Pillemer|first5=Sarah|last6=Dyke|first6=Jonathan P.|last7=Medow|first7=Marvin S.|last8=Natelson|first8=Benjamin H.|last9=Stewart|first9=Julian M.|date=Sep 2012|title=Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology|url=https://www.ncbi.nlm.nih.gov/pubmed/22281935|journal=NMR in biomedicine|volume=25|issue=9|pages=1073–1087|doi=10.1002/nbm.2772|issn=1099-1492|pmc=3896084|pmid=22281935}}</ref><ref name=":8">{{Cite journal|last=Natelson|first=Benjamin H.|last2=Vu|first2=Diana|last3=Coplan|first3=Jeremy D.|last4=Mao|first4=Xiangling|last5=Blate|first5=Michelle|last6=Kang|first6=Guoxin|last7=Soto|first7=Eli|last8=Kapusuz|first8=Tolga|last9=Shungu|first9=Dikoma C.|date=2017|title=Elevations of Ventricular Lactate Levels Occur in Both Chronic Fatigue Syndrome and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/29308330|journal=Fatigue: Biomedicine, Health & Behavior|volume=5|issue=1|pages=15–20|doi=10.1080/21641846.2017.1280114|issn=2164-1846|pmc=5754037|pmid=29308330}}</ref><ref name=":9">{{Cite journal|last=Murrough|first=James W.|last2=Mao|first2=Xiangling|last3=Collins|first3=Katherine A.|last4=Kelly|first4=Chris|last5=Andrade|first5=Gizely|last6=Nestadt|first6=Paul|last7=Levine|first7=Susan M.|last8=Mathew|first8=Sanjay J.|last9=Shungu|first9=Dikoma C.|date=Jul 2010|title=Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder|url=https://www.ncbi.nlm.nih.gov/pubmed/20661876|journal=NMR in biomedicine|volume=23|issue=6|pages=643–650|doi=10.1002/nbm.1512|issn=1099-1492|pmid=20661876}}</ref>and significantly differs from lactate levels in people with psychological disorders.<ref name=":7" /><ref name=":9" />Both ME patients and [[fibromyalgia]] patients were found to have similar levels of elevated lactate, so more tests would be needed to differentiate the two.<ref name=":8" />

Though contrasts were found between ME people and controls in many of these [[Diagnostic biomarker|biomarker]] studies, researchers are not sure what the changes mean.

=== Electrical activity ===
2016, A qEEG/LORETA study of nine controls and nine CFS patients (per [[DePaul Symptom Questionnaire]] (DSQ) and [[Canadian Consensus Criteria]] (CCC) definitions), found significantly decreased eLORETA source analysis oscillations in the occipital, parietal, posterior cingulate, and posterior temporal lobes in Alpha and Alpha-2. This research suggests that "disruptions in these regions and networks could be a neurobiological feature of the disorder, representing underlying neural dysfunction."<ref name="Zinn2016P2">{{Citation
| last1 = Zinn | first1 = Marcie | authorlink1 = Marcie Zinn
| last2 = Zinn | first2 = Mark | authorlink2 = Mark Zinn
| last3 = Jason | first3 = Leonard | authorlink3 = Leonard Jason
| title = Intrinsic Functional Hypoconnectivity in Core Neurocognitive Networks Suggests Central Nervous System Pathology in Patients with Myalgic Encephalomyelitis: A Pilot Study
| journal = Applied Psychophysiology and Biofeedback | volume = 41 | issue = 3 | page = 283-300
| date = 2016
| pmid = 26869373
| doi = 10.1007/s10484-016-9331-3
}}</ref>

2016, A qEEG/LORETA study of one CFS patient (per DSQ and CCC definitions), found deregulation of the functional connectivity networks. This may explain the common symptom of perceived cognitive deficits such as slow thinking, difficulty in reading comprehension, reduced learning and memory abilities and an overall feeling of being in a “[[Brain fog|fog]]".

<ref name=":132">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref> [[File:CLROA-2-110-F1.gif|850px|thumb|center|Figure 1: Results of LORETA current source density in a case with CFS showing widespread decreased current density for delta at 2 Hz and beta (12- 15 Hz) demonstrating a global reduction in brain functioning (blue). The higher frequencies (beta) have been shown to be a function of delta frequencies. In other words, local oscillations are under constant influence of global brain dynamics (Buzsaki, 2006).<ref name=":13">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref>|link=https://www.me-pedia.org/wiki/File:CLROA-2-110-F1.gif]]

===T2 Hyperintensities in MRI===
{{bookmark|T2 hyperintensity}}
[[File:T2hyperintensitiesVRS.jpg|400px|thumb|MRI image with small white T2 hyperintensities, which are labelled as "Virchow-Robin spaces". Use allowed for educational purposes, courtesy of radiologyassistant.nl]]
Possible white matter abnormalities of unknown etiology are found on MRIs of some [[ME/CFS]] patients.<ref name=":12">{{Cite journal|last=Natelson|first=B. H.|last2=Cohen|first2=J. M.|last3=Brassloff|first3=I.|last4=Lee|first4=H. J.|date=1993-12-15|title=A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8138812|journal=Journal of the Neurological Sciences|volume=120|issue=2|pages=213–217|doi=10.1016/0022-510x(93)90276-5|issn=0022-510X|pmid=8138812}}</ref><ref name=":14">{{Cite journal|last=Lange|first=G.|last2=DeLuca|first2=J.|last3=Maldjian|first3=J. A.|last4=Lee|first4=H.|last5=Tiersky|first5=L. A.|last6=Natelson|first6=B. H.|date=1999-12-01|title=Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10567042|journal=Journal of the Neurological Sciences|volume=171|issue=1|pages=3–7|doi=10.1016/s0022-510x(99)00243-9|issn=0022-510X|pmid=10567042}}</ref> These are identified by T2 hyperintensities, which might indicate lesions or abnormally dilated Virchow-Robin spaces.<ref>{{Cite journal|last=Kwee|first=Robert M.|last2=Kwee|first2=Thomas C.|date=2007-07-01|title=Virchow-Robin Spaces at MR Imaging|url=https://pubs.rsna.org/doi/full/10.1148/rg.274065722|journal=RadioGraphics|volume=27|issue=4|pages=1071–1086|doi=10.1148/rg.274065722|issn=0271-5333}}</ref>
* 1993, A comparison of brain MRI scans from 52 CFS patients and 52 controls found that 27% of CFS patients had findings considered abnormal, while only 2% of controls had findings considered abnormal. Abnormalities included T2 hyperintensities and ventricular enlargement.<ref name=":12" />
* 1999, A comparison of brain MRI scans from 39 CFS patients and 19 controls found that the 21 CFS patients who did not have a psychiatric diagnosis had significantly more T2 hyperintensities, compared to either controls or the 18 CFS patients with a psychiatric diagnosis.<ref name=":14" />
Since T2 hyperintensities are found in many different neurological conditions, some neurologists consider them to be diagnostically insignificant. Others point out that perhaps they should not be ignored, as they are correlated with cognitive disability and poor motor function.<ref>{{Cite journal|last=Jeong|first=Eun Hye|last2=Lee|first2=Yong Joo|last3=Kim|first3=Sang Joon|last4=Lee|first4=Jae-Hong|date=2015|title=Is the Severity of Dilated Virchow-Robin Spaces Associated with Cognitive Dysfunction?|url=http://dx.doi.org/10.12779/dnd.2015.14.3.114|journal=Dementia and Neurocognitive Disorders|volume=14|issue=3|pages=114|doi=10.12779/dnd.2015.14.3.114|issn=1738-1495}}</ref><ref>{{Cite journal|last=Sachdev|first=P. S.|last2=Wen|first2=W.|last3=Christensen|first3=H.|last4=Jorm|first4=A. F.|date=2005-03-01|title=White matter hyperintensities are related to physical disability and poor motor function|url=https://jnnp.bmj.com/content/76/3/362|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=76|issue=3|pages=362–367|doi=10.1136/jnnp.2004.042945|issn=0022-3050|pmid=15716527}}</ref>

== '''UNSORTED/unincorporated articles''' ==
*more abnormal spinal fluids<ref name="Natelson, 2017" />, and psychiatric comorbidity does not influence any of these potential biological markers of [[CFS]], <ref name="Natelson, 2017" />
*a subgroup of [[CFS]] patients with brain abnormalities may have an underlying encephalopathy producing their illness.<ref name="Natelson, 2017" />

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)|''Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder''By David Tuller - New York Times: Well]]<ref name="Tuller20141124NYT" />

*2016, One six year longitudinal study found that [[Chronic Fatigue Syndrome]] (CFS) (meeting the [[Fukuda criteria]] and [[Canadian Consensus Criteria]]) is associated with decreases in [[white matter]], [[gray matter]] and blood volume deficits in the brain as compared to healthy controls.<ref name="Shan20163">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik| first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>

*2017, A study, using segmented anatomical [[Magnetic resonance imaging|MRI]] brain scans showed that, adjusting for total [[intracranial volume]], [[CFS]] patients (as per Fukuda diagnostic criteria) had larger gray matter volume and lower white matter volume. The increased gray matter volume was predominantly found in the [[amygdala]] and [[insula]] cortex. The decreased white matter was predominantly found in the midbrain and temporal lobe.<ref name="Finkelmeyer, 20172">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}</ref>
*2020, Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Washington2020">{{Cite journal|last=Washington|first=Stuart D.|author-link=|last2=Rayhan|first2=Rakib U.|author-link2=Rakib Rayhan|last3=Garner|first3=Richard|author-link3=|last4=Provenzano|first4=Destie|author-link4=|last5=Zajur|first5=Kristina|author-link5=|last6=Addiego|first6=Florencia Martinez|author-link6=|last7=VanMeter|first7=John W.|last8=Baraniuk|first8=James N.|author-link8=James Baraniuk|date=2020-07-01|title=Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074|journal=Brain Communications|language=en|volume=2|issue=2|pages=|doi=10.1093/braincomms/fcaa070|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074 (Full text)] - see [[:Category:Images|images folder]]

== Chronic pain ==
In 2015, Loggia’s team<ref name=":1">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> successfully imaged [[neuroinflammation]]— specifically the activation of glial cells — in the brains of patients with [[chronic pain]] using a new imaging approach — a combination of [[magnetic resonance imaging]] (MRI) and [[positron emission tomography]] (PET), or MR/PET scanning.<ref name=":03">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref> MR/PET blends the structural and functional detail of tissues that an MRI gives with the sensitivity and [[metabolic]] function that PET scans provide.<ref name=":04">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>Specifically, PET scanning detects the radiation given off by a substance injected into a person, called a radiotracer, following its distribution throughout the body.<ref name=":04" />

==Notable studies==

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)]]
*2016, Relative increase in choline in the occipital cortex in chronic fatigue syndrome<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861|via=}}</ref>
*2017, CNS findings in chronic fatigue syndrome and a neuropathological case report<ref name="Ferrero, 2017" />
*2017, Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study<ref name="Finkelmeyer, 2017" />
*2018, Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients<ref>{{Cite journal|last=Staud|first=Roland|author-link=Roland Staud|last2=Robinson|first2=Michael E.|author-link2=|last3=Letzen|first3=Janelle E.|author-link3=|last4=Boissoneault|first4=Jeff|author-link4=|last5=Sevel|first5=Landrew S.|author-link5=|date=2018-08-01|title=Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients|url=https://link.springer.com/article/10.1007/s00221-018-5301-8|journal=Experimental Brain Research|language=en|volume=236|issue=8|pages=2245–2253|doi=10.1007/s00221-018-5301-8|issn=1432-1106|pmc=|pmid=29846797|quote=|via=}}</ref> [https://link.springer.com/article/10.1007/s00221-018-5301-8 (Abstract)]
*2018, Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with [[chronic fatigue syndrome]]<ref name="Zinn, 2018" /> [https://www.sciencedirect.com/science/article/pii/S0301051118304071 (Abstract)]
*2018, Brain function characteristics of [[chronic fatigue syndrome]]: A task fMRI study<ref name=":0">{{Cite journal|last=Shan|first=Zack Y.|last2=Finegan|first2=Kevin|last3=Bhuta|first3=Sandeep|last4=Ireland|first4=Timothy|last5=Staines|first5=Donald R.|last6=Marshall-Gradisnik|first6=Sonya M.|last7=Barnden|first7=Leighton R.|date=2018-01-01|others=National Centre for Neuroimmunology and Emerging Diseases; Medical Imaging Dept., Gold Coast Hosp.|title=Brain function characteristics of chronic fatigue syndrome: A task fMRI study|url=https://www.sciencedirect.com/science/article/pii/S2213158218301347|journal=NeuroImage: Clinical|language=en|volume=19|pages=279–286|doi=10.1016/j.nicl.2018.04.025|issn=2213-1582|via=Elsevier}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218301347 (Full Text)]

[[File:Brain function characteristics of chronic fatigue syndrome A task fMRI study (2018).jpeg|400px|thumb|center|Brain function characteristics of chronic fatigue syndrome: A task fMRI study (2018) <ref name=":0" /> ]]

*2018, Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Nakatomi, 2018" />
*2018, Hyperintense sensorimotor T1 spin echo [[MRI]] is associated with brainstem abnormality in [[chronic fatigue syndrome]]<ref>{{Cite journal|last=Barnden|first=Leighton R.|last2=Shan|first2=Zack Y.|last3=Staines|first3=Donald R.|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|last6=Ireland|first6=Timothy|last7=Bhuta|first7=Sandeep|date=2018|title=Hyperintense sensorimotor T1 spin echo MRI is associated with brainstem abnormality in chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S2213158218302237|journal=NeuroImage: Clinical|volume=20|pages=102-109|doi=10.1016/j.nicl.2018.07.011|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218302237 (Full Text)]
*2018, Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging<ref>{{Cite journal|last=Kimura|first=Yukio|last2=Sato|first2=Noriko|last3=Ota|first3=Miho|last4=Shigemoto|first4=Yoko|last5=Morimoto|first5=Emiko|last6=Enokizono|first6=Mikako|last7=Matsuda|first7=Hiroshi|last8=Shin|first8=Isu|last9=Amano|first9=Keiko|date=2018-11-14|title=Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247|journal=Journal of Magnetic Resonance Imaging|language=en|doi=10.1002/jmri.26247|issn=1053-1807}}</ref> [https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247?af=R (Abstract)]

*2019, Intra brainstem connectivity is impaired in chronic fatigue syndrome<ref name="brainconnectivity2019">{{Cite journal|last=Barnden|first=Leighton R|author-link=Leighton Barnden|last2=Shan|first2=Zack Y|author-link2=Zack Shan|last3=Staines|first3=Donald R|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|author-link5=|last6=Ireland|first6=Timothy|author-link6=|last7=Bhuta|first7=Sandeep|last8=|first8=|date=2019-10-19|title=Intra brainstem connectivity is impaired in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S2213158219303924|journal=NeuroImage: Clinical|volume=24|issue=|pages=102045|doi=10.1016/j.nicl.2019.102045|issn=2213-1582|pmc=|pmid=|access-date=|quote=|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158219303924 (Full text)]

==Notable studies==
*2016, [https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/ Six year study of abnormal brain changes in chronic fatigue syndrome patients]<ref>{{Cite news|url=https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/|title=Six year study of abnormal brain changes in chronic fatigue syndrome patients|last=Nimmo|first=Sasha|date=2016-07-12|work=ME Australia|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2016, [http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover A bug in fMRI software could invalidate 15 years of brain research]<ref>{{Cite news|url=http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover|title=A Bug in FMRI Software Could Invalidate 15 Years of Brain Research|last=Crew|first=Bec|date=Jul 6, 2016|work=ScienceAlert|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-gb}}</ref>
*2016, [http://www.nature.com/nature/journal/vaop/ncurrent/full/nature18933.html A multi-modal parcellation of human cerebral cortex - ''Nature''].<ref>{{Cite journal|last=Glasser|first=Matthew F.|last2=Coalson|first2=Timothy S.|last3=Robinson|first3=Emma C.|last4=Hacker|first4=Carl D.|last5=Harwell|first5=John|last6=Yacoub|first6=Essa|last7=Ugurbil|first7=Kamil|last8=Andersson|first8=Jesper|last9=Beckmann|first9=Christian F.|date=2016-07-20|title=A multi-modal parcellation of human cerebral cortex|url=https://www.nature.com/articles/nature18933|journal=Nature|language=En|volume=536|issue=7615|pages=171–178|doi=10.1038/nature18933|issn=0028-0836}}</ref>An article on this brain imaging mapping research with video appeared in [https://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force?CMP=twt_gu ''The Guardian Science''- Updated map of the human brain hailed as a scientific tour de force]<ref>{{Cite web|url=http://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force|title=Updated map of the human brain hailed as a scientific tour de force|last=Sample|first=Ian|date=2016-07-20|website=the Guardian|language=en|access-date=2018-08-23}}</ref>and [http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279 ''CNN Health''article - New brain map identifies 97 previously unknown regions].<ref>{{Cite news|url=http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279|title=Updated brain map identifies 97 new areas|last=CNN|first=Susan Scutti,|date=Jul 20, 2016|work=CNN|access-date=2018-08-23|archive-url=|archive-date=|dead-url=}}</ref>

*2016, [http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/ Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta]<ref>{{Cite news|url=http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/|title=Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta - #MEAction|last=M|first=Beth|date=2016-02-07|work=#MEAction|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/ Study Identifies the Types of Cognitive Dysfunction That Are Most Prevalent in Fibromyalgia]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/|title=Fibromyalgia Study Identifies Main Types of Patients' Cognitive Dysfunction|last=Pena|first=Amy|date=2018-03-21|work=Fibromyalgia News Today|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/ Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS)]<ref>{{Cite news|url=https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/|title=Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS) - Health Rising|last=Johnson|first=Cort|date=2018-09-24|work=Health Rising|access-date=2018-09-25|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>

*2018, [https://www.youtube.com/watch?v=rxdzaWD5wfU ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study]<ref>{{Cite web|url=https://www.youtube.com/watch?v=rxdzaWD5wfU|title=ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study|date=Dec 14, 2018|access-date=|website=YouTube|last=|first=|authorlink=Jarred Younger|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=|publisher=SolveCFS}}</ref>

*2019, [http://go.solvecfs.org/webmail/192652/97033877/74d435097e87231f24cffe4d9de93da8e3f71c0e077a67417eba10cbd269ccb1 ''Brain Imaging and Behavior'' publication from Dr. Jarred Younger’s SMCI Ramsay pilot s]

==Talks and interviews==

== See also ==
* [[Brainstem]]
* [[Spine]]
* [[Central nervous system]]
* [[Neurology of ME/CFS]]

==Learn more==
*[https://www.cortechslabs.com/neuroquant/tba/ Neuroquant Triage Brain Atrophy Report (MRI)]<ref>{{Cite web|url=https://www.cortechslabs.com/neuroquant/tba/|title=Triage Brain Atrophy Report|last=|first=|date=|website=Cortechs Labs|archive-url=|archive-date=|dead-url=|access-date=}}</ref> - Provides physicians a quick reference and in-depth look on regional and global brain structure volumes, which could occur as a result of a brain injury or in neurodegenerative disease, by providing volume measurements of 44 brain structures for both the right and left hemisphere, total structure – all sorted by lobe and region. With a detailed table of intracranial volume and right, left and total values for normative percentile of ICV. Resulting values are automatically compared to gender and age-appropriate reference distribution.
*[https://www.youtube.com/watch?v=LQ4DlE1Xyd4 2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)]<ref>{{Cite web|url=https://www.youtube.com/watch?v=LQ4DlE1Xyd4|title=2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)|last=|first=|date=Aug 22, 2014|website=YouTube|publisher=Neuroscientifically Challenged|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

==References==
<references>
<ref name="JaimeS20160505">{{citation
| author = Jaime S | authorlink1 = Jaime S
| title = Progressive Brain Changes in Patients with Chronic Fatigue Syndrome: Are our Brains Starved of Oxygen?
| journal = #MEAction
| date = 2016-05-05
| url = http://www.meaction.net/2016/05/05/progressive-brain-changes-in-patients-with-chronic-fatigue-syndrome-are-our-brains-starved-of-oxygen/
}}</ref>
<ref name="Ferrero, 2017">{{Citation
| last1 = Ferrero | first1 = Kimberly | authorlink1 =
| last2 = Silver | first2 = Mitchell | authorlink2 =
| last3 = Cocchetto | first3 = Alan | authorlink3 =
| last4 = Masliah | first4 = Eliezer | authorlink4 =
| last5 = Langford | first5 = Dianne | authorlink5 =
| title = CNS findings in chronic fatigue syndrome and a neuropathological case report
| journal = Journal of Investigative Medicine| volume = | issue = | page =
| date = 2017
| doi = 10.1136/jim-2016-000390
}}
</ref>
<ref name="Finkelmeyer, 2017">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}
</ref>
<ref name="Nakatomi, 2018">{{Citation
| last1 = Nakatomi | first1 = Y | authorlink1 =
| last2 = Kuratsune | first2 = H | authorlink2 =
| last3 = Watanabe | first3 = Y | authorlink3 = Yasuyoshi Watanabe
| title = Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
| journal = Brain Nerve | volume = 70 | issue = 1 | page = 19-25
| date = 2018
| pmid = 29348371
| doi = 10.11477/mf.1416200945
}}
</ref>
<ref name="Natelson, 2017">{{Citation
| last1 = Natelson | first1 = Benjamin | authorlink1 = Benjamin Natelson
| last2 = Mao | first2 = Xiangling | authorlink2 =
| last3 = Stegner | first3 = Aaron J | authorlink3 =
| last4 = Lange | first4 = Gudrun | authorlink4 = Gudrun Lange
| last5 = Vu | first5 = Diana | authorlink5 =
| last6 = Blate | first6 = Michelle | authorlink6 =
| last7 = Kang | first7 = Guoxin | authorlink7 =
| last8 = Soto | first8 = Eli | authorlink8 =
| last9 = Kapusuz | first9 = Tolga | authorlink9 =
| last10 = Shungu | first10 = Dikoma C | authorlink10 =
| 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 =
| doi = 10.1016/j.jns.2017.02.046
}}
</ref>
<ref name="Shan2016">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
<ref name="Zinn, 2018">{{Citation
| last1 = Zinn | first1 = Mark A. | authorlink1 = Mark Zinn
| last2 = Zinn | first2 = Marcie L. | authorlink2 = Marcie Zinn
| last3 = Valencia | first3 = Ian | authorlink3 = Ian Valencia
| last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason
| last5 = Montoya | first5 = Jose G. | authorlink5 = Jose Montoya
| title = Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome
| journal = Biological Psychology | volume = 136 | issue = 1 | page = 87-99
| date = 2018
| pmid =
| doi = 10.1016/j.biopsycho.2018.05.016
}}
</ref>
</references>
[[Category:Neurology]]
[[Category:Central nervous system]]
[[Category:Anatomy]]

Brain

2020-12-04T11:39:05Z

Spoonface:spelling

[[File:Brain diagram CNS.jpg|400px|thumb|Diagram of Brain<ref>{{Cite web|url=https://cnx.org/contents/GFy_h8cu@11.5:JOhgnBan@4/The-Central-Nervous-System|title=The Central Nervous System|last=|first=|date=29 September 2018|website=OpenStax Biology|archive-url=|archive-date=|dead-url=|access-date=29 September 2018}}</ref> License: CC-BY-4.0|alt=Diagram of brain showing Corpus callosum, cerebral cortex, cerebellum, brainsteam, amydala, thalamus, basal ganglia]]
The '''brain''' is an organ that serves as the center of the [[nervous system]] in all vertebrate and most invertebrate animals. The brain is located in the head, usually close to the sensory organs for senses such as vision. It is divided into three parts: the [[brainstem]], cerebellum and cerebrum. The brain and spinal cord make up the [[central nervous system]] (CNS).

The brain and [[spinal cord]] have their own [[immune system]].<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2019/02/190219132853.htm|title=Scientists create new map of brain's immune system|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Feb 19, 2019|website=ScienceDaily|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref> Tissue-resident macrophages, known as [[microglia]], are a part of that immune system.<ref>{{Cite web|title=Brain immune system is key to recovery from motor neuron degeneration: Results in study point to new approaches for ALS therapy|url=https://www.sciencedaily.com/releases/2018/02/180220143439.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Feb 20, 2018|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>

The brain also has its own [[lymphatic system]] which links directly to the blood-borne [[immune system]].<ref>{{Cite web|url=https://www.scientificamerican.com/article/important-link-between-the-brain-and-immune-system-found/|title=Important Link between the Brain and Immune System Found|last=Stetka|first=Bret|authorlink=|last2=|first2=|authorlink2=|date=Jul 21, 2015|website=Scientific American|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref>

Injury to the brain or [[spinal cord]], such as those caused by stroke or [[trauma]], result in a considerable weakening of the immune system.<ref>{{Cite web|title=An interconnection between the nervous and immune system: Neuroendocrine reflex triggers infections|url=https://www.sciencedaily.com/releases/2017/09/170919102530.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Sep 29, 2017|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>
==ME/CFS ==

<div role="note" class="hatnote navigation-not-searchable">''Main article: [[Neurology of ME/CFS]]''</div>

=== Anatomical changes ===
Significant changes in white and gray matter volumes have frequently been found in patients with ME/CFS but no consistent pattern has been found.<ref name="Shan2016" /><ref name="JaimeS20160505" /><ref name="Goldman20141028">{{citation
| last1 = Goldman | first1 = Bruce | authorlink1 =
| title = Study finds brain abnormalities in chronic fatigue patients
| journal = Stanford Medicine News Center
| date = 2014-10-28
| url = http://med.stanford.edu/news/all-news/2014/10/study-finds-brain-abnormalities-in-chronic-fatigue-patients.html
}}</ref><ref name="Zeineh2014">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref><ref name="Puri, 2012">{{Citation
| last1 = Puri | first1 = BK | authorlink1 = Basant Puri
| last2 = Jakeman | first2 =PM | authorlink2 =
| last3 = Agour | first3 = M | authorlink3 =
| last4 = Gunatilake | first4 = KDR | authorlink4 =
| last5 = Fernando | first5 = KAC | authorlink5 =
| last6 = Gurusinghe | first6 = AI | authorlink6 =
| last7 = Treasaden | first7 = IH | authorlink7 =
| last8 = Waldman | first8 = AD | authorlink8 =
| last9 = Gishen | first9 = P | authorlink9 =
| title = Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study
| journal = British Journal of Radiology | volume = 85 | issue = 1015 | page = e270-3
| date = 2012
| pmid =
| doi = 10.1259/bjr/93889091
}}</ref>

{| class="wikitable"
!Year
!Authors
!N
!Criteria
!Findings
!Ref
|-
|2004
|Okada, et al
|16
|
|Reduced gray-matter volume in the bilateral prefrontal cortex. Volume reduction in the right prefrontal cortex correlated with fatigue severity.
|<ref>{{Cite journal|last=Okada|first=Tomohisa|last2=Tanaka|first2=Masaaki|last3=Kuratsune|first3=Hirohiko|last4=Watanabe|first4=Yasuyoshi|last5=Sadato|first5=Norihiro|date=2004-10-04|title=Mechanisms underlying fatigue: a voxel-based morphometric study of chronic fatigue syndrome|url=https://doi.org/10.1186/1471-2377-4-14|journal=BMC Neurology|volume=4|issue=1|pages=14|doi=10.1186/1471-2377-4-14|issn=1471-2377|pmc=PMC524491|pmid=15461817}}</ref>
|-
|2016
|Shan, et al
|
|Fukuda & CCC
|Decreases in [[white matter]], [[gray matter]] and blood volume deficits
|<ref name="Shan20162">{{citation
| last1 = Shan | first1 = ZY | authorlink1 = Zack Shan
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
|-
|2012
|Basant Puri, et al
|
|
|Reduced grey matter volume in the occipital lobes, the right angular gyrus and the posterior division of the left parahippocampal gyrus.
|<ref name="Puri, 2012" />
|-
|2014
|Zeineh, et al
|
|
|Diminished white matter, white matter abnormalities in the right hemisphere.
|<ref name="Zeineh2014" />
|}

=== Blood flow ===
Several studies have ME/CFS patients have found evidence of reduced cerebral blood flow,<ref name="Natelson, 2017" /><ref name=":3" /><ref name=":10" /><ref>{{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=9–11|doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name=":11">{{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=83–86|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=767–772|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=222–226|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=50S–53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> including the [[brainstem]]<ref name=":3" /><ref name=":10" /> and cerebral cortex.<ref name=":11" />

A 1995 study found hypoperfusion (reduced blood flow) to the brainstem in patients with ME/CFS.<ref name=":3">{{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=767–773|issn=1460-2725|pmid=8542261}}</ref> In 2011, a study of brain involvement in CFS found "a strong correlation" between brainstem gray matter volume and pulse pressure, "suggesting impaired cerebrovascular autoregulation."<ref name=":10">{{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=1302–1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc=PMC4369126|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=50–58|doi=10.1016/j.cnp.2020.01.003|issn=2467-981X}}</ref>

=== Metabolism ===
A 2003 study of [[Brain|cerebral]] [[glucose]] metabolism in 26 patients with [[chronic fatigue syndrome]] via 18-fluorodeoxyglucose positron emission tomography (FDG-PET) found evidence of hypometabolism (reduced glucose consumption) in approximately half of patients.<ref>{{Cite journal|title=Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome|url=https://jnnp.bmj.com/content/74/7/922|journal=Journal of Neurology, Neurosurgery & Psychiatry|date=2003-07-01|issn=0022-3050|pmid=12810781|pages=922–928|volume=74|issue=7|doi=10.1136/jnnp.74.7.922|language=en|first=P.|last=Bartenstein|first2=U. T.|last2=Egle|first3=M.|last3=Schreckenberger|first4=J.|last4=Hardt|first5=W. A.|last5=Nix|first6=T.|last6=Siessmeier}}</ref> A 1998 PET study also found evidence of reduced metabolism in 18 patients.<ref>{{Cite journal|last=Tirelli|first=Umberto|last2=Chierichetti|first2=Franca|last3=Tavio|first3=Marcello|last4=Simonelli|first4=Cecilia|last5=Bianchin|first5=Gianluigi|last6=Zanco|first6=Pierluigi|last7=Ferlin|first7=Giorgio|date=1998-09-28|title=Brain positron emission tomography (PET) in chronic fatigue syndrome: preliminary data|url=http://www.sciencedirect.com/science/article/pii/S000293439800179X|journal=The American Journal of Medicine|volume=105|issue=3, Supplement 1|pages=54S–58S|doi=10.1016/S0002-9343(98)00179-X|issn=0002-9343}}</ref>

Patients with ME/CFS have also been found to have lower brain glutathione<ref name="Natelson, 2017" /> and higher brain ventricular lactate.<ref name="Natelson, 2017" />

Abnormal distribution of acetyl-L-carnitine uptake, which is one of the biochemical markers of chronic fatigue syndrome, in the prefrontal cortex.{{Citation needed|reason=clarify}}

=== Inflammation ===
{{Main article|page_name=Neuroinflammation}}

Whole-brain MRS markers of neuroinflammation have been found in ME/CFS.<ref name=":02">{{Cite web|url=https://link.springer.com/epdf/10.1007/s11682-018-0029-4?|title=Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy|last=|first=|authorlink=Christina Mueller|last2=|first2=|authorlink2=Joanne Lin|date=2019|website=link.springer.com|doi=10.1007/s11682-018-0029-4|archive-url=|archive-date=|dead-url=|access-date=2019-01-17|authorlink3=Sulaiman Sheriff|authorlink4=Andrew Maudsley|authorlink5=Jarred Younger}}</ref> fMRI images document neuroinflammation.<ref name="Zeineh20143">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref>

In 2014, A Japanese [[positron emission tomography]] (PET) study looked at [[neuroinflammation]] in nine patients with ME/CFS and ten controls. They measured a protein expressed by activated [[microglia]], and found that values in the [[cingulate cortex]], [[hippocampus]], [[amygdala]], [[thalamus]], [[midbrain]], and [[pons]] were 45%–199% higher in ME/CFS patients than in healthy controls. The values in the amygdala, thalamus, and midbrain positively correlated with cognitive impairment score, the values in the cingulate cortex and thalamus positively correlated with pain score, and the value in the hippocampus positively correlated with depression score.<ref name="Nakatomi2014">{{citation
| last1 = Nakatomi | first1 = Yasuhito | authorlink1 =
| last2 = Mizuno | first2 = Kei | authorlink2 =
| last3 = Ishii | first3 = Akira | authorlink3 =
| last4 = Wada | first4 = Yasuhiro | authorlink4 =
| last5 = Tanaka | first5 = Masaaki | authorlink5 =
| last6 = Tazawa | first6 = Shusaku | authorlink6 =
| last7 = Onoe | first7 = Kayo | authorlink7 =
| last8 = Fukuda | first8 = Sanae | authorlink8 =
| last9 = Kawabe | first9 = Joji | authorlink9 =
| last10 = Takahashi | first10= Kazuhiro | authorlink10=
| last11 = Kataoka | first11= Yosky | authorlink11=
| last12 = Shiomi | first12= Susumu | authorlink12=
| last13 = Yamaguti | first13= Kouzi | authorlink13=
| last14 = Inaba | first14= Masaaki | authorlink14=
| last15 = Kuratsune | first15= Hirohiko | authorlink15=
| last16 = Watanabe | first16= Yasuyoshi | authorlink16= Yasuyoshi Watanabe
| display-authors = 3
| title = Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An ¹¹C-(R)-PK11195 PET Study
| journal = Journal of Nuclear Medicine | volume = 2014 Jun;55(6) | page = 945-50
| date = 2014-03-24
| pmid = 24665088 | doi = 10.2967/jnumed.113.131045
| url = http://jnm.snmjournals.org/content/55/6/945.long
}}</ref><ref name="Tuller20141124NYT">{{citation
| last1 = Tuller | first1 = David | authorlink1 = David Tuller
| title = Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder
| journal = NY Times
| date = 2014-11-24
| url = http://well.blogs.nytimes.com/2014/11/24/brains-of-people-with-chronic-fatigue-syndrome-offer-clues-about-disorder/?_r=0
}}</ref>

2019, [[Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy (2019) Mueller, et al|Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy]], Mueller, et al.<ref name=":022" /><blockquote>This study is the first to investigate whole-brain MRS markers of neuroinflammation in ME/CFS. We report [[metabolite]] and temperature abnormalities in ME/CFS patients in widely distributed brain areas, suggesting ME/CFS is driven by diffuse pathophysiological processes affecting the whole brain, rather than regionally limited, which is consistent with the heterogeneity of its clinical symptoms. Our findings add support to the hypothesis that ME/CFS is the result of chronic, low-level neuroinflammation. While the whole-brain results are preliminary, we note that they largely agree with past publications that use MRS in ME/CFS. These results should be replicated in future studies with larger samples to further establish the profile of pathophysiological abnormalities in the brains of ME/CFS patients. Ultimately, the development of sensitive MRI markers of ME/CFS could supplement clinical tests to help guide treatment decisions.<ref name=":022" /></blockquote>

Several neurochemicals have been studied in relation to ME patients. Myo-inositol is thought to be involved in astrocyte function (Albrecht et al. 2016) and trended to be higher in ME patients compared to controls.<ref name=":5">{{Cite journal|last=Brooks|first=J. C.|last2=Roberts|first2=N.|last3=Whitehouse|first3=G.|last4=Majeed|first4=T.|date=Nov 2000|title=Proton magnetic resonance spectroscopy and morphometry of the hippocampus in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11144799|journal=The British Journal of Radiology|volume=73|issue=875|pages=1206–1208|doi=10.1259/bjr.73.875.11144799|issn=0007-1285|pmid=11144799}}</ref>

N-acetylacetate (NAA) shows neuron density, which has been found in other neurological disorders<ref name=":2">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Granziera|first2=Cristina|last3=Hooker|first3=Jacob M.|last4=Loggia|first4=Marco L.|date=2016-04-20|title=In Vivo Imaging of Human Neuroinflammation|url=https://www.ncbi.nlm.nih.gov/pubmed/26985861|journal=ACS chemical neuroscience|volume=7|issue=4|pages=470–483|doi=10.1021/acschemneuro.6b00056|issn=1948-7193|pmc=5433433|pmid=26985861}}</ref>and has been shown to be lower in ME patients,<ref name=":4">{{Cite journal|last=Chaudhuri|first=A.|last2=Condon|first2=B. R.|last3=Gow|first3=J. W.|last4=Brennan|first4=D.|last5=Hadley|first5=D. M.|date=2003-02-10|title=Proton magnetic resonance spectroscopy of basal ganglia in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12598734|journal=Neuroreport|volume=14|issue=2|pages=225–228|doi=10.1097/01.wnr.0000054960.21656.64|issn=0959-4965|pmid=12598734}}</ref><ref name=":5" />but this was not found in all studies.<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=Nov 2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861}}</ref><ref name=":6">{{Cite journal|last=Tomoda|first=A.|last2=Miike|first2=T.|last3=Yamada|first3=E.|last4=Honda|first4=H.|last5=Moroi|first5=T.|last6=Ogawa|first6=M.|last7=Ohtani|first7=Y.|last8=Morishita|first8=S.|date=Jan 2000|title=Chronic fatigue syndrome in childhood|url=https://www.ncbi.nlm.nih.gov/pubmed/10761837|journal=Brain & Development|volume=22|issue=1|pages=60–64|issn=0387-7604|pmid=10761837}}</ref>

[[Choline]] is linked to activation of glia, loss of energy and expression of macrophages in the brain<ref name=":2" />and has been shown to change compared to controls.<ref name=":4" /><ref name=":5" /><ref name=":6" /><ref>{{Cite journal|last=Puri|first=B. K.|last2=Agour|first2=M.|last3=Gunatilake|first3=K. D. R.|last4=Fernando|first4=K. a. C.|last5=Gurusinghe|first5=A. I.|last6=Treasaden|first6=I. H.|date=Nov 2009|title=An in vivo proton neurospectroscopy study of cerebral oxidative stress in myalgic encephalomyelitis (chronic fatigue syndrome)|url=https://www.ncbi.nlm.nih.gov/pubmed/19906518|journal=Prostaglandins, Leukotrienes, and Essential Fatty Acids|volume=81|issue=5-6|pages=303–305|doi=10.1016/j.plefa.2009.10.002|issn=1532-2823|pmid=19906518}}</ref>

Lactate increases when more energy is being expended and has been shown to be higher than controls,<ref name=":7">{{Cite journal|last=Mathew|first=Sanjay J.|last2=Mao|first2=Xiangling|last3=Keegan|first3=Kathryn A.|last4=Levine|first4=Susan M.|last5=Smith|first5=Eric L. P.|last6=Heier|first6=Linda A.|last7=Otcheretko|first7=Viktor|last8=Coplan|first8=Jeremy D.|last9=Shungu|first9=Dikoma C.|date=Apr 2009|title=Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: an in vivo 3.0 T (1)H MRS imaging study|url=https://www.ncbi.nlm.nih.gov/pubmed/18942064|journal=NMR in biomedicine|volume=22|issue=3|pages=251–258|doi=10.1002/nbm.1315|issn=0952-3480|pmid=18942064}}</ref><ref>{{Cite journal|last=Shungu|first=Dikoma C.|last2=Weiduschat|first2=Nora|last3=Murrough|first3=James W.|last4=Mao|first4=Xiangling|last5=Pillemer|first5=Sarah|last6=Dyke|first6=Jonathan P.|last7=Medow|first7=Marvin S.|last8=Natelson|first8=Benjamin H.|last9=Stewart|first9=Julian M.|date=Sep 2012|title=Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology|url=https://www.ncbi.nlm.nih.gov/pubmed/22281935|journal=NMR in biomedicine|volume=25|issue=9|pages=1073–1087|doi=10.1002/nbm.2772|issn=1099-1492|pmc=3896084|pmid=22281935}}</ref><ref name=":8">{{Cite journal|last=Natelson|first=Benjamin H.|last2=Vu|first2=Diana|last3=Coplan|first3=Jeremy D.|last4=Mao|first4=Xiangling|last5=Blate|first5=Michelle|last6=Kang|first6=Guoxin|last7=Soto|first7=Eli|last8=Kapusuz|first8=Tolga|last9=Shungu|first9=Dikoma C.|date=2017|title=Elevations of Ventricular Lactate Levels Occur in Both Chronic Fatigue Syndrome and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/29308330|journal=Fatigue: Biomedicine, Health & Behavior|volume=5|issue=1|pages=15–20|doi=10.1080/21641846.2017.1280114|issn=2164-1846|pmc=5754037|pmid=29308330}}</ref><ref name=":9">{{Cite journal|last=Murrough|first=James W.|last2=Mao|first2=Xiangling|last3=Collins|first3=Katherine A.|last4=Kelly|first4=Chris|last5=Andrade|first5=Gizely|last6=Nestadt|first6=Paul|last7=Levine|first7=Susan M.|last8=Mathew|first8=Sanjay J.|last9=Shungu|first9=Dikoma C.|date=Jul 2010|title=Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder|url=https://www.ncbi.nlm.nih.gov/pubmed/20661876|journal=NMR in biomedicine|volume=23|issue=6|pages=643–650|doi=10.1002/nbm.1512|issn=1099-1492|pmid=20661876}}</ref>and significantly differs from lactate levels in people with psychological disorders.<ref name=":7" /><ref name=":9" />Both ME patients and [[fibromyalgia]] patients were found to have similar levels of elevated lactate, so more tests would be needed to differentiate the two.<ref name=":8" />

Though contrasts were found between ME people and controls in many of these [[Diagnostic biomarker|biomarker]] studies, researchers are not sure what the changes mean.

=== Electrical activity ===
2016, A qEEG/LORETA study of nine controls and nine CFS patients (per [[DePaul Symptom Questionnaire]] (DSQ) and [[Canadian Consensus Criteria]] (CCC) definitions), found significantly decreased eLORETA source analysis oscillations in the occipital, parietal, posterior cingulate, and posterior temporal lobes in Alpha and Alpha-2. This research suggests that "disruptions in these regions and networks could be a neurobiological feature of the disorder, representing underlying neural dysfunction."<ref name="Zinn2016P2">{{Citation
| last1 = Zinn | first1 = Marcie | authorlink1 = Marcie Zinn
| last2 = Zinn | first2 = Mark | authorlink2 = Mark Zinn
| last3 = Jason | first3 = Leonard | authorlink3 = Leonard Jason
| title = Intrinsic Functional Hypoconnectivity in Core Neurocognitive Networks Suggests Central Nervous System Pathology in Patients with Myalgic Encephalomyelitis: A Pilot Study
| journal = Applied Psychophysiology and Biofeedback | volume = 41 | issue = 3 | page = 283-300
| date = 2016
| pmid = 26869373
| doi = 10.1007/s10484-016-9331-3
}}</ref>

2016, A qEEG/LORETA study of one CFS patient (per DSQ and CCC definitions), found deregulation of the functional connectivity networks. This may explain the common symptom of perceived cognitive deficits such as slow thinking, difficulty in reading comprehension, reduced learning and memory abilities and an overall feeling of being in a “[[Brain fog|fog]]".

<ref name=":132">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref> [[File:CLROA-2-110-F1.gif|850px|thumb|center|Figure 1: Results of LORETA current source density in a case with CFS showing widespread decreased current density for delta at 2 Hz and beta (12- 15 Hz) demonstrating a global reduction in brain functioning (blue). The higher frequencies (beta) have been shown to be a function of delta frequencies. In other words, local oscillations are under constant influence of global brain dynamics (Buzsaki, 2006).<ref name=":13">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref>|link=https://www.me-pedia.org/wiki/File:CLROA-2-110-F1.gif]]

===T2 Hyperintensities in MRI===
{{bookmark|T2 hyperintensity}}
[[File:T2hyperintensitiesVRS.jpg|400px|thumb|MRI image with small white T2 hyperintensities, which are labelled as "Virchow-Robin spaces". Use allowed for educational purposes, courtesy of radiologyassistant.nl]]
Possible white matter abnormalities of unknown etiology are found on MRIs of some [[ME/CFS]] patients.<ref name=":12">{{Cite journal|last=Natelson|first=B. H.|last2=Cohen|first2=J. M.|last3=Brassloff|first3=I.|last4=Lee|first4=H. J.|date=1993-12-15|title=A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8138812|journal=Journal of the Neurological Sciences|volume=120|issue=2|pages=213–217|doi=10.1016/0022-510x(93)90276-5|issn=0022-510X|pmid=8138812}}</ref><ref name=":14">{{Cite journal|last=Lange|first=G.|last2=DeLuca|first2=J.|last3=Maldjian|first3=J. A.|last4=Lee|first4=H.|last5=Tiersky|first5=L. A.|last6=Natelson|first6=B. H.|date=1999-12-01|title=Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10567042|journal=Journal of the Neurological Sciences|volume=171|issue=1|pages=3–7|doi=10.1016/s0022-510x(99)00243-9|issn=0022-510X|pmid=10567042}}</ref> These are identified by T2 hyperintensities, which might indicate lesions or abnormally dilated Virchow-Robin spaces.<ref>{{Cite journal|last=Kwee|first=Robert M.|last2=Kwee|first2=Thomas C.|date=2007-07-01|title=Virchow-Robin Spaces at MR Imaging|url=https://pubs.rsna.org/doi/full/10.1148/rg.274065722|journal=RadioGraphics|volume=27|issue=4|pages=1071–1086|doi=10.1148/rg.274065722|issn=0271-5333}}</ref>
* 1993, A comparison of brain MRI scans from 52 CFS patients and 52 controls found that 27% of CFS patients had findings considered abnormal, while only 2% of controls had findings considered abnormal. Abnormalities included T2 hyperintensities and ventricular enlargement.<ref name=":12" />
* 1999, A comparison of brain MRI scans from 39 CFS patients and 19 controls found that the 21 CFS patients who did not have a psychiatric diagnosis had significantly more T2 hyperintensities, compared to either controls or the 18 CFS patients with a psychiatric diagnosis.<ref name=":14" />
Since T2 hyperintensities are found in many different neurological conditions, some neurologists consider them to be diagnostically insignificant. Others point out that perhaps they should not be ignored, as they are correlated with cognitive disability and poor motor function.<ref>{{Cite journal|last=Jeong|first=Eun Hye|last2=Lee|first2=Yong Joo|last3=Kim|first3=Sang Joon|last4=Lee|first4=Jae-Hong|date=2015|title=Is the Severity of Dilated Virchow-Robin Spaces Associated with Cognitive Dysfunction?|url=http://dx.doi.org/10.12779/dnd.2015.14.3.114|journal=Dementia and Neurocognitive Disorders|volume=14|issue=3|pages=114|doi=10.12779/dnd.2015.14.3.114|issn=1738-1495}}</ref><ref>{{Cite journal|last=Sachdev|first=P. S.|last2=Wen|first2=W.|last3=Christensen|first3=H.|last4=Jorm|first4=A. F.|date=2005-03-01|title=White matter hyperintensities are related to physical disability and poor motor function|url=https://jnnp.bmj.com/content/76/3/362|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=76|issue=3|pages=362–367|doi=10.1136/jnnp.2004.042945|issn=0022-3050|pmid=15716527}}</ref>

=== Tarlov cysts ===
Perineural cysts or Tarlov cysts (TCs) are nerve root dilations resulting from pathologically increased cerebrospinal fluid pressure.

A study of 197 ME/CFS patients found that the prevalence of Tarlov cysts was three times higher in ME/CFS patients than the general population, at 39%.<ref>{{Cite journal|last=Hulens|first=Mieke|last2=Bruyninckx|first2=Frans|last3=Dankaerts|first3=Wim|last4=Rasschaert|first4=Ricky|last5=De Mulder|first5=Peter|last6=Stalmans|first6=Ingeborg|last7=Vansant|first7=Greet|last8=Bervoets|first8=Chris|date=2020-12-01|title=High Prevalence of Perineural Cysts in Patients with Fibromyalgia and Chronic Fatigue Syndrome|url=https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaa410/6015822|journal=Pain Medicine|language=en|pages=pnaa410|doi=10.1093/pm/pnaa410|issn=1526-2375}}</ref>

Tarlov cyst patients often complain about widespread pain and fatigue.

The study's authors conclude:<blockquote>This observation supports the hypothesis that STCs, FM, and CFS may share the same pathophysiological mechanism, i.e., moderately increased cerebrospinal fluid pressure, causing irritation of neurons and axons in dorsal root ganglia</blockquote>

== '''UNSORTED/unincorporated articles''' ==
*more abnormal spinal fluids<ref name="Natelson, 2017" />, and psychiatric comorbidity does not influence any of these potential biological markers of [[CFS]], <ref name="Natelson, 2017" />
*a subgroup of [[CFS]] patients with brain abnormalities may have an underlying encephalopathy producing their illness.<ref name="Natelson, 2017" />

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)|''Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder''By David Tuller - New York Times: Well]]<ref name="Tuller20141124NYT" />

*2016, One six year longitudinal study found that [[Chronic Fatigue Syndrome]] (CFS) (meeting the [[Fukuda criteria]] and [[Canadian Consensus Criteria]]) is associated with decreases in [[white matter]], [[gray matter]] and blood volume deficits in the brain as compared to healthy controls.<ref name="Shan20163">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik| first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>

*2017, A study, using segmented anatomical [[Magnetic resonance imaging|MRI]] brain scans showed that, adjusting for total [[intracranial volume]], [[CFS]] patients (as per Fukuda diagnostic criteria) had larger gray matter volume and lower white matter volume. The increased gray matter volume was predominantly found in the [[amygdala]] and [[insula]] cortex. The decreased white matter was predominantly found in the midbrain and temporal lobe.<ref name="Finkelmeyer, 20172">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}</ref>
*2020, Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Washington2020">{{Cite journal|last=Washington|first=Stuart D.|author-link=|last2=Rayhan|first2=Rakib U.|author-link2=Rakib Rayhan|last3=Garner|first3=Richard|author-link3=|last4=Provenzano|first4=Destie|author-link4=|last5=Zajur|first5=Kristina|author-link5=|last6=Addiego|first6=Florencia Martinez|author-link6=|last7=VanMeter|first7=John W.|last8=Baraniuk|first8=James N.|author-link8=James Baraniuk|date=2020-07-01|title=Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074|journal=Brain Communications|language=en|volume=2|issue=2|pages=|doi=10.1093/braincomms/fcaa070|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074 (Full text)] - see [[:Category:Images|images folder]]

== Chronic pain ==
In 2015, Loggia’s team<ref name=":1">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> successfully imaged [[neuroinflammation]]— specifically the activation of glial cells — in the brains of patients with [[chronic pain]] using a new imaging approach — a combination of [[magnetic resonance imaging]] (MRI) and [[positron emission tomography]] (PET), or MR/PET scanning.<ref name=":03">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref> MR/PET blends the structural and functional detail of tissues that an MRI gives with the sensitivity and [[metabolic]] function that PET scans provide.<ref name=":04">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>Specifically, PET scanning detects the radiation given off by a substance injected into a person, called a radiotracer, following its distribution throughout the body.<ref name=":04" />

==Notable studies==

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)]]
*2016, Relative increase in choline in the occipital cortex in chronic fatigue syndrome<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861|via=}}</ref>
*2017, CNS findings in chronic fatigue syndrome and a neuropathological case report<ref name="Ferrero, 2017" />
*2017, Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study<ref name="Finkelmeyer, 2017" />
*2018, Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients<ref>{{Cite journal|last=Staud|first=Roland|author-link=Roland Staud|last2=Robinson|first2=Michael E.|author-link2=|last3=Letzen|first3=Janelle E.|author-link3=|last4=Boissoneault|first4=Jeff|author-link4=|last5=Sevel|first5=Landrew S.|author-link5=|date=2018-08-01|title=Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients|url=https://link.springer.com/article/10.1007/s00221-018-5301-8|journal=Experimental Brain Research|language=en|volume=236|issue=8|pages=2245–2253|doi=10.1007/s00221-018-5301-8|issn=1432-1106|pmc=|pmid=29846797|quote=|via=}}</ref> [https://link.springer.com/article/10.1007/s00221-018-5301-8 (Abstract)]
*2018, Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with [[chronic fatigue syndrome]]<ref name="Zinn, 2018" /> [https://www.sciencedirect.com/science/article/pii/S0301051118304071 (Abstract)]
*2018, Brain function characteristics of [[chronic fatigue syndrome]]: A task fMRI study<ref name=":0">{{Cite journal|last=Shan|first=Zack Y.|last2=Finegan|first2=Kevin|last3=Bhuta|first3=Sandeep|last4=Ireland|first4=Timothy|last5=Staines|first5=Donald R.|last6=Marshall-Gradisnik|first6=Sonya M.|last7=Barnden|first7=Leighton R.|date=2018-01-01|others=National Centre for Neuroimmunology and Emerging Diseases; Medical Imaging Dept., Gold Coast Hosp.|title=Brain function characteristics of chronic fatigue syndrome: A task fMRI study|url=https://www.sciencedirect.com/science/article/pii/S2213158218301347|journal=NeuroImage: Clinical|language=en|volume=19|pages=279–286|doi=10.1016/j.nicl.2018.04.025|issn=2213-1582|via=Elsevier}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218301347 (Full Text)]

[[File:Brain function characteristics of chronic fatigue syndrome A task fMRI study (2018).jpeg|400px|thumb|center|Brain function characteristics of chronic fatigue syndrome: A task fMRI study (2018) <ref name=":0" /> ]]

*2018, Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Nakatomi, 2018" />
*2018, Hyperintense sensorimotor T1 spin echo [[MRI]] is associated with brainstem abnormality in [[chronic fatigue syndrome]]<ref>{{Cite journal|last=Barnden|first=Leighton R.|last2=Shan|first2=Zack Y.|last3=Staines|first3=Donald R.|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|last6=Ireland|first6=Timothy|last7=Bhuta|first7=Sandeep|date=2018|title=Hyperintense sensorimotor T1 spin echo MRI is associated with brainstem abnormality in chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S2213158218302237|journal=NeuroImage: Clinical|volume=20|pages=102-109|doi=10.1016/j.nicl.2018.07.011|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218302237 (Full Text)]
*2018, Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging<ref>{{Cite journal|last=Kimura|first=Yukio|last2=Sato|first2=Noriko|last3=Ota|first3=Miho|last4=Shigemoto|first4=Yoko|last5=Morimoto|first5=Emiko|last6=Enokizono|first6=Mikako|last7=Matsuda|first7=Hiroshi|last8=Shin|first8=Isu|last9=Amano|first9=Keiko|date=2018-11-14|title=Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247|journal=Journal of Magnetic Resonance Imaging|language=en|doi=10.1002/jmri.26247|issn=1053-1807}}</ref> [https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247?af=R (Abstract)]

*2019, Intra brainstem connectivity is impaired in chronic fatigue syndrome<ref name="brainconnectivity2019">{{Cite journal|last=Barnden|first=Leighton R|author-link=Leighton Barnden|last2=Shan|first2=Zack Y|author-link2=Zack Shan|last3=Staines|first3=Donald R|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|author-link5=|last6=Ireland|first6=Timothy|author-link6=|last7=Bhuta|first7=Sandeep|last8=|first8=|date=2019-10-19|title=Intra brainstem connectivity is impaired in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S2213158219303924|journal=NeuroImage: Clinical|volume=24|issue=|pages=102045|doi=10.1016/j.nicl.2019.102045|issn=2213-1582|pmc=|pmid=|access-date=|quote=|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158219303924 (Full text)]

==Notable studies==
*2016, [https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/ Six year study of abnormal brain changes in chronic fatigue syndrome patients]<ref>{{Cite news|url=https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/|title=Six year study of abnormal brain changes in chronic fatigue syndrome patients|last=Nimmo|first=Sasha|date=2016-07-12|work=ME Australia|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2016, [http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover A bug in fMRI software could invalidate 15 years of brain research]<ref>{{Cite news|url=http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover|title=A Bug in FMRI Software Could Invalidate 15 Years of Brain Research|last=Crew|first=Bec|date=Jul 6, 2016|work=ScienceAlert|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-gb}}</ref>
*2016, [http://www.nature.com/nature/journal/vaop/ncurrent/full/nature18933.html A multi-modal parcellation of human cerebral cortex - ''Nature''].<ref>{{Cite journal|last=Glasser|first=Matthew F.|last2=Coalson|first2=Timothy S.|last3=Robinson|first3=Emma C.|last4=Hacker|first4=Carl D.|last5=Harwell|first5=John|last6=Yacoub|first6=Essa|last7=Ugurbil|first7=Kamil|last8=Andersson|first8=Jesper|last9=Beckmann|first9=Christian F.|date=2016-07-20|title=A multi-modal parcellation of human cerebral cortex|url=https://www.nature.com/articles/nature18933|journal=Nature|language=En|volume=536|issue=7615|pages=171–178|doi=10.1038/nature18933|issn=0028-0836}}</ref>An article on this brain imaging mapping research with video appeared in [https://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force?CMP=twt_gu ''The Guardian Science''- Updated map of the human brain hailed as a scientific tour de force]<ref>{{Cite web|url=http://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force|title=Updated map of the human brain hailed as a scientific tour de force|last=Sample|first=Ian|date=2016-07-20|website=the Guardian|language=en|access-date=2018-08-23}}</ref>and [http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279 ''CNN Health''article - New brain map identifies 97 previously unknown regions].<ref>{{Cite news|url=http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279|title=Updated brain map identifies 97 new areas|last=CNN|first=Susan Scutti,|date=Jul 20, 2016|work=CNN|access-date=2018-08-23|archive-url=|archive-date=|dead-url=}}</ref>

*2016, [http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/ Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta]<ref>{{Cite news|url=http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/|title=Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta - #MEAction|last=M|first=Beth|date=2016-02-07|work=#MEAction|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/ Study Identifies the Types of Cognitive Dysfunction That Are Most Prevalent in Fibromyalgia]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/|title=Fibromyalgia Study Identifies Main Types of Patients' Cognitive Dysfunction|last=Pena|first=Amy|date=2018-03-21|work=Fibromyalgia News Today|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/ Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS)]<ref>{{Cite news|url=https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/|title=Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS) - Health Rising|last=Johnson|first=Cort|date=2018-09-24|work=Health Rising|access-date=2018-09-25|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>

*2018, [https://www.youtube.com/watch?v=rxdzaWD5wfU ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study]<ref>{{Cite web|url=https://www.youtube.com/watch?v=rxdzaWD5wfU|title=ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study|date=Dec 14, 2018|access-date=|website=YouTube|last=|first=|authorlink=Jarred Younger|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=|publisher=SolveCFS}}</ref>

*2019, [http://go.solvecfs.org/webmail/192652/97033877/74d435097e87231f24cffe4d9de93da8e3f71c0e077a67417eba10cbd269ccb1 ''Brain Imaging and Behavior'' publication from Dr. Jarred Younger’s SMCI Ramsay pilot s]

==Talks and interviews==

== See also ==
* [[Brainstem]]
* [[Central nervous system]]
* [[Neurology of ME/CFS]]

==Learn more==
*[https://www.cortechslabs.com/neuroquant/tba/ Neuroquant Triage Brain Atrophy Report (MRI)]<ref>{{Cite web|url=https://www.cortechslabs.com/neuroquant/tba/|title=Triage Brain Atrophy Report|last=|first=|date=|website=Cortechs Labs|archive-url=|archive-date=|dead-url=|access-date=}}</ref> - Provides physicians a quick reference and in-depth look on regional and global brain structure volumes, which could occur as a result of a brain injury or in neurodegenerative disease, by providing volume measurements of 44 brain structures for both the right and left hemisphere, total structure – all sorted by lobe and region. With a detailed table of intracranial volume and right, left and total values for normative percentile of ICV. Resulting values are automatically compared to gender and age-appropriate reference distribution.
*[https://www.youtube.com/watch?v=LQ4DlE1Xyd4 2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)]<ref>{{Cite web|url=https://www.youtube.com/watch?v=LQ4DlE1Xyd4|title=2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)|last=|first=|date=Aug 22, 2014|website=YouTube|publisher=Neuroscientifically Challenged|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

==References==
<references>
<ref name="JaimeS20160505">{{citation
| author = Jaime S | authorlink1 = Jaime S
| title = Progressive Brain Changes in Patients with Chronic Fatigue Syndrome: Are our Brains Starved of Oxygen?
| journal = #MEAction
| date = 2016-05-05
| url = http://www.meaction.net/2016/05/05/progressive-brain-changes-in-patients-with-chronic-fatigue-syndrome-are-our-brains-starved-of-oxygen/
}}</ref>
<ref name="Ferrero, 2017">{{Citation
| last1 = Ferrero | first1 = Kimberly | authorlink1 =
| last2 = Silver | first2 = Mitchell | authorlink2 =
| last3 = Cocchetto | first3 = Alan | authorlink3 =
| last4 = Masliah | first4 = Eliezer | authorlink4 =
| last5 = Langford | first5 = Dianne | authorlink5 =
| title = CNS findings in chronic fatigue syndrome and a neuropathological case report
| journal = Journal of Investigative Medicine| volume = | issue = | page =
| date = 2017
| doi = 10.1136/jim-2016-000390
}}
</ref>
<ref name="Finkelmeyer, 2017">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}
</ref>
<ref name="Nakatomi, 2018">{{Citation
| last1 = Nakatomi | first1 = Y | authorlink1 =
| last2 = Kuratsune | first2 = H | authorlink2 =
| last3 = Watanabe | first3 = Y | authorlink3 = Yasuyoshi Watanabe
| title = Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
| journal = Brain Nerve | volume = 70 | issue = 1 | page = 19-25
| date = 2018
| pmid = 29348371
| doi = 10.11477/mf.1416200945
}}
</ref>
<ref name="Natelson, 2017">{{Citation
| last1 = Natelson | first1 = Benjamin | authorlink1 = Benjamin Natelson
| last2 = Mao | first2 = Xiangling | authorlink2 =
| last3 = Stegner | first3 = Aaron J | authorlink3 =
| last4 = Lange | first4 = Gudrun | authorlink4 = Gudrun Lange
| last5 = Vu | first5 = Diana | authorlink5 =
| last6 = Blate | first6 = Michelle | authorlink6 =
| last7 = Kang | first7 = Guoxin | authorlink7 =
| last8 = Soto | first8 = Eli | authorlink8 =
| last9 = Kapusuz | first9 = Tolga | authorlink9 =
| last10 = Shungu | first10 = Dikoma C | authorlink10 =
| 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 =
| doi = 10.1016/j.jns.2017.02.046
}}
</ref>
<ref name="Shan2016">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
<ref name="Zinn, 2018">{{Citation
| last1 = Zinn | first1 = Mark A. | authorlink1 = Mark Zinn
| last2 = Zinn | first2 = Marcie L. | authorlink2 = Marcie Zinn
| last3 = Valencia | first3 = Ian | authorlink3 = Ian Valencia
| last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason
| last5 = Montoya | first5 = Jose G. | authorlink5 = Jose Montoya
| title = Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome
| journal = Biological Psychology | volume = 136 | issue = 1 | page = 87-99
| date = 2018
| pmid =
| doi = 10.1016/j.biopsycho.2018.05.016
}}
</ref>
</references>
[[Category:Neurology]]
[[Category:Central nervous system]]
[[Category:Anatomy]]

Brain

2020-12-04T11:29:33Z

Spoonface:Tarlov cyst paper

[[File:Brain diagram CNS.jpg|400px|thumb|Diagram of Brain<ref>{{Cite web|url=https://cnx.org/contents/GFy_h8cu@11.5:JOhgnBan@4/The-Central-Nervous-System|title=The Central Nervous System|last=|first=|date=29 September 2018|website=OpenStax Biology|archive-url=|archive-date=|dead-url=|access-date=29 September 2018}}</ref> License: CC-BY-4.0|alt=Diagram of brain showing Corpus callosum, cerebral cortex, cerebellum, brainsteam, amydala, thalamus, basal ganglia]]
The '''brain''' is an organ that serves as the center of the [[nervous system]] in all vertebrate and most invertebrate animals. The brain is located in the head, usually close to the sensory organs for senses such as vision. It is divided into three parts: the [[brainstem]], cerebellum and cerebrum. The brain and spinal cord make up the [[central nervous system]] (CNS).

The brain and [[spinal cord]] have their own [[immune system]].<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2019/02/190219132853.htm|title=Scientists create new map of brain's immune system|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Feb 19, 2019|website=ScienceDaily|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref> Tissue-resident macrophages, known as [[microglia]], are a part of that immune system.<ref>{{Cite web|title=Brain immune system is key to recovery from motor neuron degeneration: Results in study point to new approaches for ALS therapy|url=https://www.sciencedaily.com/releases/2018/02/180220143439.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Feb 20, 2018|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>

The brain also has its own [[lymphatic system]] which links directly to the blood-borne [[immune system]].<ref>{{Cite web|url=https://www.scientificamerican.com/article/important-link-between-the-brain-and-immune-system-found/|title=Important Link between the Brain and Immune System Found|last=Stetka|first=Bret|authorlink=|last2=|first2=|authorlink2=|date=Jul 21, 2015|website=Scientific American|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref>

Injury to the brain or [[spinal cord]], such as those caused by stroke or [[trauma]], result in a considerable weakening of the immune system.<ref>{{Cite web|title=An interconnection between the nervous and immune system: Neuroendocrine reflex triggers infections|url=https://www.sciencedaily.com/releases/2017/09/170919102530.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Sep 29, 2017|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>
==ME/CFS ==

<div role="note" class="hatnote navigation-not-searchable">''Main article: [[Neurology of ME/CFS]]''</div>

=== Anatomical changes ===
Significant changes in white and gray matter volumes have frequently been found in patients with ME/CFS but no consistent pattern has been found.<ref name="Shan2016" /><ref name="JaimeS20160505" /><ref name="Goldman20141028">{{citation
| last1 = Goldman | first1 = Bruce | authorlink1 =
| title = Study finds brain abnormalities in chronic fatigue patients
| journal = Stanford Medicine News Center
| date = 2014-10-28
| url = http://med.stanford.edu/news/all-news/2014/10/study-finds-brain-abnormalities-in-chronic-fatigue-patients.html
}}</ref><ref name="Zeineh2014">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref><ref name="Puri, 2012">{{Citation
| last1 = Puri | first1 = BK | authorlink1 = Basant Puri
| last2 = Jakeman | first2 =PM | authorlink2 =
| last3 = Agour | first3 = M | authorlink3 =
| last4 = Gunatilake | first4 = KDR | authorlink4 =
| last5 = Fernando | first5 = KAC | authorlink5 =
| last6 = Gurusinghe | first6 = AI | authorlink6 =
| last7 = Treasaden | first7 = IH | authorlink7 =
| last8 = Waldman | first8 = AD | authorlink8 =
| last9 = Gishen | first9 = P | authorlink9 =
| title = Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study
| journal = British Journal of Radiology | volume = 85 | issue = 1015 | page = e270-3
| date = 2012
| pmid =
| doi = 10.1259/bjr/93889091
}}</ref>

{| class="wikitable"
!Year
!Authors
!N
!Criteria
!Findings
!Ref
|-
|2004
|Okada, et al
|16
|
|Reduced gray-matter volume in the bilateral prefrontal cortex. Volume reduction in the right prefrontal cortex correlated with fatigue severity.
|<ref>{{Cite journal|last=Okada|first=Tomohisa|last2=Tanaka|first2=Masaaki|last3=Kuratsune|first3=Hirohiko|last4=Watanabe|first4=Yasuyoshi|last5=Sadato|first5=Norihiro|date=2004-10-04|title=Mechanisms underlying fatigue: a voxel-based morphometric study of chronic fatigue syndrome|url=https://doi.org/10.1186/1471-2377-4-14|journal=BMC Neurology|volume=4|issue=1|pages=14|doi=10.1186/1471-2377-4-14|issn=1471-2377|pmc=PMC524491|pmid=15461817}}</ref>
|-
|2016
|Shan, et al
|
|Fukuda & CCC
|Decreases in [[white matter]], [[gray matter]] and blood volume deficits
|<ref name="Shan20162">{{citation
| last1 = Shan | first1 = ZY | authorlink1 = Zack Shan
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
|-
|2012
|Basant Puri, et al
|
|
|Reduced grey matter volume in the occipital lobes, the right angular gyrus and the posterior division of the left parahippocampal gyrus.
|<ref name="Puri, 2012" />
|-
|2014
|Zeineh, et al
|
|
|Diminished white matter, white matter abnormalities in the right hemisphere.
|<ref name="Zeineh2014" />
|}

=== Blood flow ===
Several studies have ME/CFS patients have found evidence of reduced cerebral blood flow,<ref name="Natelson, 2017" /><ref name=":3" /><ref name=":10" /><ref>{{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=9–11|doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name=":11">{{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=83–86|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=767–772|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=222–226|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=50S–53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> including the [[brainstem]]<ref name=":3" /><ref name=":10" /> and cerebral cortex.<ref name=":11" />

A 1995 study found hypoperfusion (reduced blood flow) to the brainstem in patients with ME/CFS.<ref name=":3">{{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=767–773|issn=1460-2725|pmid=8542261}}</ref> In 2011, a study of brain involvement in CFS found "a strong correlation" between brainstem gray matter volume and pulse pressure, "suggesting impaired cerebrovascular autoregulation."<ref name=":10">{{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=1302–1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc=PMC4369126|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=50–58|doi=10.1016/j.cnp.2020.01.003|issn=2467-981X}}</ref>

=== Metabolism ===
A 2003 study of [[Brain|cerebral]] [[glucose]] metabolism in 26 patients with [[chronic fatigue syndrome]] via 18-fluorodeoxyglucose positron emission tomography (FDG-PET) found evidence of hypometabolism (reduced glucose consumption) in approximately half of patients.<ref>{{Cite journal|title=Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome|url=https://jnnp.bmj.com/content/74/7/922|journal=Journal of Neurology, Neurosurgery & Psychiatry|date=2003-07-01|issn=0022-3050|pmid=12810781|pages=922–928|volume=74|issue=7|doi=10.1136/jnnp.74.7.922|language=en|first=P.|last=Bartenstein|first2=U. T.|last2=Egle|first3=M.|last3=Schreckenberger|first4=J.|last4=Hardt|first5=W. A.|last5=Nix|first6=T.|last6=Siessmeier}}</ref> A 1998 PET study also found evidence of reduced metabolism in 18 patients.<ref>{{Cite journal|last=Tirelli|first=Umberto|last2=Chierichetti|first2=Franca|last3=Tavio|first3=Marcello|last4=Simonelli|first4=Cecilia|last5=Bianchin|first5=Gianluigi|last6=Zanco|first6=Pierluigi|last7=Ferlin|first7=Giorgio|date=1998-09-28|title=Brain positron emission tomography (PET) in chronic fatigue syndrome: preliminary data|url=http://www.sciencedirect.com/science/article/pii/S000293439800179X|journal=The American Journal of Medicine|volume=105|issue=3, Supplement 1|pages=54S–58S|doi=10.1016/S0002-9343(98)00179-X|issn=0002-9343}}</ref>

Patients with ME/CFS have also been found to have lower brain glutathione<ref name="Natelson, 2017" /> and higher brain ventricular lactate.<ref name="Natelson, 2017" />

Abnormal distribution of acetyl-L-carnitine uptake, which is one of the biochemical markers of chronic fatigue syndrome, in the prefrontal cortex.{{Citation needed|reason=clarify}}

=== Inflammation ===
{{Main article|page_name=Neuroinflammation}}

Whole-brain MRS markers of neuroinflammation have been found in ME/CFS.<ref name=":02">{{Cite web|url=https://link.springer.com/epdf/10.1007/s11682-018-0029-4?|title=Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy|last=|first=|authorlink=Christina Mueller|last2=|first2=|authorlink2=Joanne Lin|date=2019|website=link.springer.com|doi=10.1007/s11682-018-0029-4|archive-url=|archive-date=|dead-url=|access-date=2019-01-17|authorlink3=Sulaiman Sheriff|authorlink4=Andrew Maudsley|authorlink5=Jarred Younger}}</ref> fMRI images document neuroinflammation.<ref name="Zeineh20143">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref>

In 2014, A Japanese [[positron emission tomography]] (PET) study looked at [[neuroinflammation]] in nine patients with ME/CFS and ten controls. They measured a protein expressed by activated [[microglia]], and found that values in the [[cingulate cortex]], [[hippocampus]], [[amygdala]], [[thalamus]], [[midbrain]], and [[pons]] were 45%–199% higher in ME/CFS patients than in healthy controls. The values in the amygdala, thalamus, and midbrain positively correlated with cognitive impairment score, the values in the cingulate cortex and thalamus positively correlated with pain score, and the value in the hippocampus positively correlated with depression score.<ref name="Nakatomi2014">{{citation
| last1 = Nakatomi | first1 = Yasuhito | authorlink1 =
| last2 = Mizuno | first2 = Kei | authorlink2 =
| last3 = Ishii | first3 = Akira | authorlink3 =
| last4 = Wada | first4 = Yasuhiro | authorlink4 =
| last5 = Tanaka | first5 = Masaaki | authorlink5 =
| last6 = Tazawa | first6 = Shusaku | authorlink6 =
| last7 = Onoe | first7 = Kayo | authorlink7 =
| last8 = Fukuda | first8 = Sanae | authorlink8 =
| last9 = Kawabe | first9 = Joji | authorlink9 =
| last10 = Takahashi | first10= Kazuhiro | authorlink10=
| last11 = Kataoka | first11= Yosky | authorlink11=
| last12 = Shiomi | first12= Susumu | authorlink12=
| last13 = Yamaguti | first13= Kouzi | authorlink13=
| last14 = Inaba | first14= Masaaki | authorlink14=
| last15 = Kuratsune | first15= Hirohiko | authorlink15=
| last16 = Watanabe | first16= Yasuyoshi | authorlink16= Yasuyoshi Watanabe
| display-authors = 3
| title = Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An ¹¹C-(R)-PK11195 PET Study
| journal = Journal of Nuclear Medicine | volume = 2014 Jun;55(6) | page = 945-50
| date = 2014-03-24
| pmid = 24665088 | doi = 10.2967/jnumed.113.131045
| url = http://jnm.snmjournals.org/content/55/6/945.long
}}</ref><ref name="Tuller20141124NYT">{{citation
| last1 = Tuller | first1 = David | authorlink1 = David Tuller
| title = Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder
| journal = NY Times
| date = 2014-11-24
| url = http://well.blogs.nytimes.com/2014/11/24/brains-of-people-with-chronic-fatigue-syndrome-offer-clues-about-disorder/?_r=0
}}</ref>

2019, [[Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy (2019) Mueller, et al|Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy]], Mueller, et al.<ref name=":022" /><blockquote>This study is the first to investigate whole-brain MRS markers of neuroinflammation in ME/CFS. We report [[metabolite]] and temperature abnormalities in ME/CFS patients in widely distributed brain areas, suggesting ME/CFS is driven by diffuse pathophysiological processes affecting the whole brain, rather than regionally limited, which is consistent with the heterogeneity of its clinical symptoms. Our findings add support to the hypothesis that ME/CFS is the result of chronic, low-level neuroinflammation. While the whole-brain results are preliminary, we note that they largely agree with past publications that use MRS in ME/CFS. These results should be replicated in future studies with larger samples to further establish the profile of pathophysiological abnormalities in the brains of ME/CFS patients. Ultimately, the development of sensitive MRI markers of ME/CFS could supplement clinical tests to help guide treatment decisions.<ref name=":022" /></blockquote>

Several neurochemicals have been studied in relation to ME patients. Myo-inositol is thought to be involved in astrocyte function (Albrecht et al. 2016) and trended to be higher in ME patients compared to controls.<ref name=":5">{{Cite journal|last=Brooks|first=J. C.|last2=Roberts|first2=N.|last3=Whitehouse|first3=G.|last4=Majeed|first4=T.|date=Nov 2000|title=Proton magnetic resonance spectroscopy and morphometry of the hippocampus in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11144799|journal=The British Journal of Radiology|volume=73|issue=875|pages=1206–1208|doi=10.1259/bjr.73.875.11144799|issn=0007-1285|pmid=11144799}}</ref>

N-acetylacetate (NAA) shows neuron density, which has been found in other neurological disorders<ref name=":2">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Granziera|first2=Cristina|last3=Hooker|first3=Jacob M.|last4=Loggia|first4=Marco L.|date=2016-04-20|title=In Vivo Imaging of Human Neuroinflammation|url=https://www.ncbi.nlm.nih.gov/pubmed/26985861|journal=ACS chemical neuroscience|volume=7|issue=4|pages=470–483|doi=10.1021/acschemneuro.6b00056|issn=1948-7193|pmc=5433433|pmid=26985861}}</ref>and has been shown to be lower in ME patients,<ref name=":4">{{Cite journal|last=Chaudhuri|first=A.|last2=Condon|first2=B. R.|last3=Gow|first3=J. W.|last4=Brennan|first4=D.|last5=Hadley|first5=D. M.|date=2003-02-10|title=Proton magnetic resonance spectroscopy of basal ganglia in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12598734|journal=Neuroreport|volume=14|issue=2|pages=225–228|doi=10.1097/01.wnr.0000054960.21656.64|issn=0959-4965|pmid=12598734}}</ref><ref name=":5" />but this was not found in all studies.<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=Nov 2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861}}</ref><ref name=":6">{{Cite journal|last=Tomoda|first=A.|last2=Miike|first2=T.|last3=Yamada|first3=E.|last4=Honda|first4=H.|last5=Moroi|first5=T.|last6=Ogawa|first6=M.|last7=Ohtani|first7=Y.|last8=Morishita|first8=S.|date=Jan 2000|title=Chronic fatigue syndrome in childhood|url=https://www.ncbi.nlm.nih.gov/pubmed/10761837|journal=Brain & Development|volume=22|issue=1|pages=60–64|issn=0387-7604|pmid=10761837}}</ref>

[[Choline]] is linked to activation of glia, loss of energy and expression of macrophages in the brain<ref name=":2" />and has been shown to change compared to controls.<ref name=":4" /><ref name=":5" /><ref name=":6" /><ref>{{Cite journal|last=Puri|first=B. K.|last2=Agour|first2=M.|last3=Gunatilake|first3=K. D. R.|last4=Fernando|first4=K. a. C.|last5=Gurusinghe|first5=A. I.|last6=Treasaden|first6=I. H.|date=Nov 2009|title=An in vivo proton neurospectroscopy study of cerebral oxidative stress in myalgic encephalomyelitis (chronic fatigue syndrome)|url=https://www.ncbi.nlm.nih.gov/pubmed/19906518|journal=Prostaglandins, Leukotrienes, and Essential Fatty Acids|volume=81|issue=5-6|pages=303–305|doi=10.1016/j.plefa.2009.10.002|issn=1532-2823|pmid=19906518}}</ref>

Lactate increases when more energy is being expended and has been shown to be higher than controls,<ref name=":7">{{Cite journal|last=Mathew|first=Sanjay J.|last2=Mao|first2=Xiangling|last3=Keegan|first3=Kathryn A.|last4=Levine|first4=Susan M.|last5=Smith|first5=Eric L. P.|last6=Heier|first6=Linda A.|last7=Otcheretko|first7=Viktor|last8=Coplan|first8=Jeremy D.|last9=Shungu|first9=Dikoma C.|date=Apr 2009|title=Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: an in vivo 3.0 T (1)H MRS imaging study|url=https://www.ncbi.nlm.nih.gov/pubmed/18942064|journal=NMR in biomedicine|volume=22|issue=3|pages=251–258|doi=10.1002/nbm.1315|issn=0952-3480|pmid=18942064}}</ref><ref>{{Cite journal|last=Shungu|first=Dikoma C.|last2=Weiduschat|first2=Nora|last3=Murrough|first3=James W.|last4=Mao|first4=Xiangling|last5=Pillemer|first5=Sarah|last6=Dyke|first6=Jonathan P.|last7=Medow|first7=Marvin S.|last8=Natelson|first8=Benjamin H.|last9=Stewart|first9=Julian M.|date=Sep 2012|title=Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology|url=https://www.ncbi.nlm.nih.gov/pubmed/22281935|journal=NMR in biomedicine|volume=25|issue=9|pages=1073–1087|doi=10.1002/nbm.2772|issn=1099-1492|pmc=3896084|pmid=22281935}}</ref><ref name=":8">{{Cite journal|last=Natelson|first=Benjamin H.|last2=Vu|first2=Diana|last3=Coplan|first3=Jeremy D.|last4=Mao|first4=Xiangling|last5=Blate|first5=Michelle|last6=Kang|first6=Guoxin|last7=Soto|first7=Eli|last8=Kapusuz|first8=Tolga|last9=Shungu|first9=Dikoma C.|date=2017|title=Elevations of Ventricular Lactate Levels Occur in Both Chronic Fatigue Syndrome and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/29308330|journal=Fatigue: Biomedicine, Health & Behavior|volume=5|issue=1|pages=15–20|doi=10.1080/21641846.2017.1280114|issn=2164-1846|pmc=5754037|pmid=29308330}}</ref><ref name=":9">{{Cite journal|last=Murrough|first=James W.|last2=Mao|first2=Xiangling|last3=Collins|first3=Katherine A.|last4=Kelly|first4=Chris|last5=Andrade|first5=Gizely|last6=Nestadt|first6=Paul|last7=Levine|first7=Susan M.|last8=Mathew|first8=Sanjay J.|last9=Shungu|first9=Dikoma C.|date=Jul 2010|title=Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder|url=https://www.ncbi.nlm.nih.gov/pubmed/20661876|journal=NMR in biomedicine|volume=23|issue=6|pages=643–650|doi=10.1002/nbm.1512|issn=1099-1492|pmid=20661876}}</ref>and significantly differs from lactate levels in people with psychological disorders.<ref name=":7" /><ref name=":9" />Both ME patients and [[fibromyalgia]] patients were found to have similar levels of elevated lactate, so more tests would be needed to differentiate the two.<ref name=":8" />

Though contrasts were found between ME people and controls in many of these [[Diagnostic biomarker|biomarker]] studies, researchers are not sure what the changes mean.

=== Electrical activity ===
2016, A qEEG/LORETA study of nine controls and nine CFS patients (per [[DePaul Symptom Questionnaire]] (DSQ) and [[Canadian Consensus Criteria]] (CCC) definitions), found significantly decreased eLORETA source analysis oscillations in the occipital, parietal, posterior cingulate, and posterior temporal lobes in Alpha and Alpha-2. This research suggests that "disruptions in these regions and networks could be a neurobiological feature of the disorder, representing underlying neural dysfunction."<ref name="Zinn2016P2">{{Citation
| last1 = Zinn | first1 = Marcie | authorlink1 = Marcie Zinn
| last2 = Zinn | first2 = Mark | authorlink2 = Mark Zinn
| last3 = Jason | first3 = Leonard | authorlink3 = Leonard Jason
| title = Intrinsic Functional Hypoconnectivity in Core Neurocognitive Networks Suggests Central Nervous System Pathology in Patients with Myalgic Encephalomyelitis: A Pilot Study
| journal = Applied Psychophysiology and Biofeedback | volume = 41 | issue = 3 | page = 283-300
| date = 2016
| pmid = 26869373
| doi = 10.1007/s10484-016-9331-3
}}</ref>

2016, A qEEG/LORETA study of one CFS patient (per DSQ and CCC definitions), found deregulation of the functional connectivity networks. This may explain the common symptom of perceived cognitive deficits such as slow thinking, difficulty in reading comprehension, reduced learning and memory abilities and an overall feeling of being in a “[[Brain fog|fog]]".

<ref name=":132">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref> [[File:CLROA-2-110-F1.gif|850px|thumb|center|Figure 1: Results of LORETA current source density in a case with CFS showing widespread decreased current density for delta at 2 Hz and beta (12- 15 Hz) demonstrating a global reduction in brain functioning (blue). The higher frequencies (beta) have been shown to be a function of delta frequencies. In other words, local oscillations are under constant influence of global brain dynamics (Buzsaki, 2006).<ref name=":13">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref>|link=https://www.me-pedia.org/wiki/File:CLROA-2-110-F1.gif]]

===T2 Hyperintensities in MRI===
{{bookmark|T2 hyperintensity}}
[[File:T2hyperintensitiesVRS.jpg|400px|thumb|MRI image with small white T2 hyperintensities, which are labelled as "Virchow-Robin spaces". Use allowed for educational purposes, courtesy of radiologyassistant.nl]]
Possible white matter abnormalities of unknown etiology are found on MRIs of some [[ME/CFS]] patients.<ref name=":12">{{Cite journal|last=Natelson|first=B. H.|last2=Cohen|first2=J. M.|last3=Brassloff|first3=I.|last4=Lee|first4=H. J.|date=1993-12-15|title=A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8138812|journal=Journal of the Neurological Sciences|volume=120|issue=2|pages=213–217|doi=10.1016/0022-510x(93)90276-5|issn=0022-510X|pmid=8138812}}</ref><ref name=":14">{{Cite journal|last=Lange|first=G.|last2=DeLuca|first2=J.|last3=Maldjian|first3=J. A.|last4=Lee|first4=H.|last5=Tiersky|first5=L. A.|last6=Natelson|first6=B. H.|date=1999-12-01|title=Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10567042|journal=Journal of the Neurological Sciences|volume=171|issue=1|pages=3–7|doi=10.1016/s0022-510x(99)00243-9|issn=0022-510X|pmid=10567042}}</ref> These are identified by T2 hyperintensities, which might indicate lesions or abnormally dilated Virchow-Robin spaces.<ref>{{Cite journal|last=Kwee|first=Robert M.|last2=Kwee|first2=Thomas C.|date=2007-07-01|title=Virchow-Robin Spaces at MR Imaging|url=https://pubs.rsna.org/doi/full/10.1148/rg.274065722|journal=RadioGraphics|volume=27|issue=4|pages=1071–1086|doi=10.1148/rg.274065722|issn=0271-5333}}</ref>
* 1993, A comparison of brain MRI scans from 52 CFS patients and 52 controls found that 27% of CFS patients had findings considered abnormal, while only 2% of controls had findings considered abnormal. Abnormalities included T2 hyperintensities and ventricular enlargement.<ref name=":12" />
* 1999, A comparison of brain MRI scans from 39 CFS patients and 19 controls found that the 21 CFS patients who did not have a psychiatric diagnosis had significantly more T2 hyperintensities, compared to either controls or the 18 CFS patients with a psychiatric diagnosis.<ref name=":14" />
Since T2 hyperintensities are found in many different neurological conditions, some neurologists consider them to be diagnostically insignificant. Others point out that perhaps they should not be ignored, as they are correlated with cognitive disability and poor motor function.<ref>{{Cite journal|last=Jeong|first=Eun Hye|last2=Lee|first2=Yong Joo|last3=Kim|first3=Sang Joon|last4=Lee|first4=Jae-Hong|date=2015|title=Is the Severity of Dilated Virchow-Robin Spaces Associated with Cognitive Dysfunction?|url=http://dx.doi.org/10.12779/dnd.2015.14.3.114|journal=Dementia and Neurocognitive Disorders|volume=14|issue=3|pages=114|doi=10.12779/dnd.2015.14.3.114|issn=1738-1495}}</ref><ref>{{Cite journal|last=Sachdev|first=P. S.|last2=Wen|first2=W.|last3=Christensen|first3=H.|last4=Jorm|first4=A. F.|date=2005-03-01|title=White matter hyperintensities are related to physical disability and poor motor function|url=https://jnnp.bmj.com/content/76/3/362|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=76|issue=3|pages=362–367|doi=10.1136/jnnp.2004.042945|issn=0022-3050|pmid=15716527}}</ref>

=== Tarlov cysts ===
Perineural cysts or Tarlov cysts (TCs) are nerve root dilations resulting from pathologically increased cerebrospinal fluid pressure.

A study of 197 ME/CFS patients found that the prevalance of Tarlov cysts was three times higher in ME/CFS patients than the general population, at 39%.<ref>{{Cite journal|last=Hulens|first=Mieke|last2=Bruyninckx|first2=Frans|last3=Dankaerts|first3=Wim|last4=Rasschaert|first4=Ricky|last5=De Mulder|first5=Peter|last6=Stalmans|first6=Ingeborg|last7=Vansant|first7=Greet|last8=Bervoets|first8=Chris|date=2020-12-01|title=High Prevalence of Perineural Cysts in Patients with Fibromyalgia and Chronic Fatigue Syndrome|url=https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaa410/6015822|journal=Pain Medicine|language=en|pages=pnaa410|doi=10.1093/pm/pnaa410|issn=1526-2375}}</ref>

Tarlov cyst patients often complain about widespread pain and fatigue.

The study's authors conclude:<blockquote>This observation supports the hypothesis that STCs, FM, and CFS may share the same pathophysiological mechanism, i.e., moderately increased cerebrospinal fluid pressure, causing irritation of neurons and axons in dorsal root ganglia</blockquote>

== '''UNSORTED/unincorporated articles''' ==
*more abnormal spinal fluids<ref name="Natelson, 2017" />, and psychiatric comorbidity does not influence any of these potential biological markers of [[CFS]], <ref name="Natelson, 2017" />
*a subgroup of [[CFS]] patients with brain abnormalities may have an underlying encephalopathy producing their illness.<ref name="Natelson, 2017" />

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)|''Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder''By David Tuller - New York Times: Well]]<ref name="Tuller20141124NYT" />

*2016, One six year longitudinal study found that [[Chronic Fatigue Syndrome]] (CFS) (meeting the [[Fukuda criteria]] and [[Canadian Consensus Criteria]]) is associated with decreases in [[white matter]], [[gray matter]] and blood volume deficits in the brain as compared to healthy controls.<ref name="Shan20163">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik| first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>

*2017, A study, using segmented anatomical [[Magnetic resonance imaging|MRI]] brain scans showed that, adjusting for total [[intracranial volume]], [[CFS]] patients (as per Fukuda diagnostic criteria) had larger gray matter volume and lower white matter volume. The increased gray matter volume was predominantly found in the [[amygdala]] and [[insula]] cortex. The decreased white matter was predominantly found in the midbrain and temporal lobe.<ref name="Finkelmeyer, 20172">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}</ref>
*2020, Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Washington2020">{{Cite journal|last=Washington|first=Stuart D.|author-link=|last2=Rayhan|first2=Rakib U.|author-link2=Rakib Rayhan|last3=Garner|first3=Richard|author-link3=|last4=Provenzano|first4=Destie|author-link4=|last5=Zajur|first5=Kristina|author-link5=|last6=Addiego|first6=Florencia Martinez|author-link6=|last7=VanMeter|first7=John W.|last8=Baraniuk|first8=James N.|author-link8=James Baraniuk|date=2020-07-01|title=Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074|journal=Brain Communications|language=en|volume=2|issue=2|pages=|doi=10.1093/braincomms/fcaa070|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074 (Full text)] - see [[:Category:Images|images folder]]

== Chronic pain ==
In 2015, Loggia’s team<ref name=":1">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> successfully imaged [[neuroinflammation]]— specifically the activation of glial cells — in the brains of patients with [[chronic pain]] using a new imaging approach — a combination of [[magnetic resonance imaging]] (MRI) and [[positron emission tomography]] (PET), or MR/PET scanning.<ref name=":03">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref> MR/PET blends the structural and functional detail of tissues that an MRI gives with the sensitivity and [[metabolic]] function that PET scans provide.<ref name=":04">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>Specifically, PET scanning detects the radiation given off by a substance injected into a person, called a radiotracer, following its distribution throughout the body.<ref name=":04" />

==Notable studies==

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)]]
*2016, Relative increase in choline in the occipital cortex in chronic fatigue syndrome<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861|via=}}</ref>
*2017, CNS findings in chronic fatigue syndrome and a neuropathological case report<ref name="Ferrero, 2017" />
*2017, Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study<ref name="Finkelmeyer, 2017" />
*2018, Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients<ref>{{Cite journal|last=Staud|first=Roland|author-link=Roland Staud|last2=Robinson|first2=Michael E.|author-link2=|last3=Letzen|first3=Janelle E.|author-link3=|last4=Boissoneault|first4=Jeff|author-link4=|last5=Sevel|first5=Landrew S.|author-link5=|date=2018-08-01|title=Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients|url=https://link.springer.com/article/10.1007/s00221-018-5301-8|journal=Experimental Brain Research|language=en|volume=236|issue=8|pages=2245–2253|doi=10.1007/s00221-018-5301-8|issn=1432-1106|pmc=|pmid=29846797|quote=|via=}}</ref> [https://link.springer.com/article/10.1007/s00221-018-5301-8 (Abstract)]
*2018, Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with [[chronic fatigue syndrome]]<ref name="Zinn, 2018" /> [https://www.sciencedirect.com/science/article/pii/S0301051118304071 (Abstract)]
*2018, Brain function characteristics of [[chronic fatigue syndrome]]: A task fMRI study<ref name=":0">{{Cite journal|last=Shan|first=Zack Y.|last2=Finegan|first2=Kevin|last3=Bhuta|first3=Sandeep|last4=Ireland|first4=Timothy|last5=Staines|first5=Donald R.|last6=Marshall-Gradisnik|first6=Sonya M.|last7=Barnden|first7=Leighton R.|date=2018-01-01|others=National Centre for Neuroimmunology and Emerging Diseases; Medical Imaging Dept., Gold Coast Hosp.|title=Brain function characteristics of chronic fatigue syndrome: A task fMRI study|url=https://www.sciencedirect.com/science/article/pii/S2213158218301347|journal=NeuroImage: Clinical|language=en|volume=19|pages=279–286|doi=10.1016/j.nicl.2018.04.025|issn=2213-1582|via=Elsevier}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218301347 (Full Text)]

[[File:Brain function characteristics of chronic fatigue syndrome A task fMRI study (2018).jpeg|400px|thumb|center|Brain function characteristics of chronic fatigue syndrome: A task fMRI study (2018) <ref name=":0" /> ]]

*2018, Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Nakatomi, 2018" />
*2018, Hyperintense sensorimotor T1 spin echo [[MRI]] is associated with brainstem abnormality in [[chronic fatigue syndrome]]<ref>{{Cite journal|last=Barnden|first=Leighton R.|last2=Shan|first2=Zack Y.|last3=Staines|first3=Donald R.|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|last6=Ireland|first6=Timothy|last7=Bhuta|first7=Sandeep|date=2018|title=Hyperintense sensorimotor T1 spin echo MRI is associated with brainstem abnormality in chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S2213158218302237|journal=NeuroImage: Clinical|volume=20|pages=102-109|doi=10.1016/j.nicl.2018.07.011|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218302237 (Full Text)]
*2018, Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging<ref>{{Cite journal|last=Kimura|first=Yukio|last2=Sato|first2=Noriko|last3=Ota|first3=Miho|last4=Shigemoto|first4=Yoko|last5=Morimoto|first5=Emiko|last6=Enokizono|first6=Mikako|last7=Matsuda|first7=Hiroshi|last8=Shin|first8=Isu|last9=Amano|first9=Keiko|date=2018-11-14|title=Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247|journal=Journal of Magnetic Resonance Imaging|language=en|doi=10.1002/jmri.26247|issn=1053-1807}}</ref> [https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247?af=R (Abstract)]

*2019, Intra brainstem connectivity is impaired in chronic fatigue syndrome<ref name="brainconnectivity2019">{{Cite journal|last=Barnden|first=Leighton R|author-link=Leighton Barnden|last2=Shan|first2=Zack Y|author-link2=Zack Shan|last3=Staines|first3=Donald R|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|author-link5=|last6=Ireland|first6=Timothy|author-link6=|last7=Bhuta|first7=Sandeep|last8=|first8=|date=2019-10-19|title=Intra brainstem connectivity is impaired in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S2213158219303924|journal=NeuroImage: Clinical|volume=24|issue=|pages=102045|doi=10.1016/j.nicl.2019.102045|issn=2213-1582|pmc=|pmid=|access-date=|quote=|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158219303924 (Full text)]

==Notable studies==
*2016, [https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/ Six year study of abnormal brain changes in chronic fatigue syndrome patients]<ref>{{Cite news|url=https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/|title=Six year study of abnormal brain changes in chronic fatigue syndrome patients|last=Nimmo|first=Sasha|date=2016-07-12|work=ME Australia|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2016, [http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover A bug in fMRI software could invalidate 15 years of brain research]<ref>{{Cite news|url=http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover|title=A Bug in FMRI Software Could Invalidate 15 Years of Brain Research|last=Crew|first=Bec|date=Jul 6, 2016|work=ScienceAlert|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-gb}}</ref>
*2016, [http://www.nature.com/nature/journal/vaop/ncurrent/full/nature18933.html A multi-modal parcellation of human cerebral cortex - ''Nature''].<ref>{{Cite journal|last=Glasser|first=Matthew F.|last2=Coalson|first2=Timothy S.|last3=Robinson|first3=Emma C.|last4=Hacker|first4=Carl D.|last5=Harwell|first5=John|last6=Yacoub|first6=Essa|last7=Ugurbil|first7=Kamil|last8=Andersson|first8=Jesper|last9=Beckmann|first9=Christian F.|date=2016-07-20|title=A multi-modal parcellation of human cerebral cortex|url=https://www.nature.com/articles/nature18933|journal=Nature|language=En|volume=536|issue=7615|pages=171–178|doi=10.1038/nature18933|issn=0028-0836}}</ref>An article on this brain imaging mapping research with video appeared in [https://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force?CMP=twt_gu ''The Guardian Science''- Updated map of the human brain hailed as a scientific tour de force]<ref>{{Cite web|url=http://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force|title=Updated map of the human brain hailed as a scientific tour de force|last=Sample|first=Ian|date=2016-07-20|website=the Guardian|language=en|access-date=2018-08-23}}</ref>and [http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279 ''CNN Health''article - New brain map identifies 97 previously unknown regions].<ref>{{Cite news|url=http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279|title=Updated brain map identifies 97 new areas|last=CNN|first=Susan Scutti,|date=Jul 20, 2016|work=CNN|access-date=2018-08-23|archive-url=|archive-date=|dead-url=}}</ref>

*2016, [http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/ Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta]<ref>{{Cite news|url=http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/|title=Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta - #MEAction|last=M|first=Beth|date=2016-02-07|work=#MEAction|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/ Study Identifies the Types of Cognitive Dysfunction That Are Most Prevalent in Fibromyalgia]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/|title=Fibromyalgia Study Identifies Main Types of Patients' Cognitive Dysfunction|last=Pena|first=Amy|date=2018-03-21|work=Fibromyalgia News Today|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/ Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS)]<ref>{{Cite news|url=https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/|title=Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS) - Health Rising|last=Johnson|first=Cort|date=2018-09-24|work=Health Rising|access-date=2018-09-25|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>

*2018, [https://www.youtube.com/watch?v=rxdzaWD5wfU ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study]<ref>{{Cite web|url=https://www.youtube.com/watch?v=rxdzaWD5wfU|title=ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study|date=Dec 14, 2018|access-date=|website=YouTube|last=|first=|authorlink=Jarred Younger|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=|publisher=SolveCFS}}</ref>

*2019, [http://go.solvecfs.org/webmail/192652/97033877/74d435097e87231f24cffe4d9de93da8e3f71c0e077a67417eba10cbd269ccb1 ''Brain Imaging and Behavior'' publication from Dr. Jarred Younger’s SMCI Ramsay pilot s]

==Talks and interviews==

== See also ==
* [[Brainstem]]
* [[Central nervous system]]
* [[Neurology of ME/CFS]]

==Learn more==
*[https://www.cortechslabs.com/neuroquant/tba/ Neuroquant Triage Brain Atrophy Report (MRI)]<ref>{{Cite web|url=https://www.cortechslabs.com/neuroquant/tba/|title=Triage Brain Atrophy Report|last=|first=|date=|website=Cortechs Labs|archive-url=|archive-date=|dead-url=|access-date=}}</ref> - Provides physicians a quick reference and in-depth look on regional and global brain structure volumes, which could occur as a result of a brain injury or in neurodegenerative disease, by providing volume measurements of 44 brain structures for both the right and left hemisphere, total structure – all sorted by lobe and region. With a detailed table of intracranial volume and right, left and total values for normative percentile of ICV. Resulting values are automatically compared to gender and age-appropriate reference distribution.
*[https://www.youtube.com/watch?v=LQ4DlE1Xyd4 2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)]<ref>{{Cite web|url=https://www.youtube.com/watch?v=LQ4DlE1Xyd4|title=2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)|last=|first=|date=Aug 22, 2014|website=YouTube|publisher=Neuroscientifically Challenged|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

==References==
<references>
<ref name="JaimeS20160505">{{citation
| author = Jaime S | authorlink1 = Jaime S
| title = Progressive Brain Changes in Patients with Chronic Fatigue Syndrome: Are our Brains Starved of Oxygen?
| journal = #MEAction
| date = 2016-05-05
| url = http://www.meaction.net/2016/05/05/progressive-brain-changes-in-patients-with-chronic-fatigue-syndrome-are-our-brains-starved-of-oxygen/
}}</ref>
<ref name="Ferrero, 2017">{{Citation
| last1 = Ferrero | first1 = Kimberly | authorlink1 =
| last2 = Silver | first2 = Mitchell | authorlink2 =
| last3 = Cocchetto | first3 = Alan | authorlink3 =
| last4 = Masliah | first4 = Eliezer | authorlink4 =
| last5 = Langford | first5 = Dianne | authorlink5 =
| title = CNS findings in chronic fatigue syndrome and a neuropathological case report
| journal = Journal of Investigative Medicine| volume = | issue = | page =
| date = 2017
| doi = 10.1136/jim-2016-000390
}}
</ref>
<ref name="Finkelmeyer, 2017">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}
</ref>
<ref name="Nakatomi, 2018">{{Citation
| last1 = Nakatomi | first1 = Y | authorlink1 =
| last2 = Kuratsune | first2 = H | authorlink2 =
| last3 = Watanabe | first3 = Y | authorlink3 = Yasuyoshi Watanabe
| title = Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
| journal = Brain Nerve | volume = 70 | issue = 1 | page = 19-25
| date = 2018
| pmid = 29348371
| doi = 10.11477/mf.1416200945
}}
</ref>
<ref name="Natelson, 2017">{{Citation
| last1 = Natelson | first1 = Benjamin | authorlink1 = Benjamin Natelson
| last2 = Mao | first2 = Xiangling | authorlink2 =
| last3 = Stegner | first3 = Aaron J | authorlink3 =
| last4 = Lange | first4 = Gudrun | authorlink4 = Gudrun Lange
| last5 = Vu | first5 = Diana | authorlink5 =
| last6 = Blate | first6 = Michelle | authorlink6 =
| last7 = Kang | first7 = Guoxin | authorlink7 =
| last8 = Soto | first8 = Eli | authorlink8 =
| last9 = Kapusuz | first9 = Tolga | authorlink9 =
| last10 = Shungu | first10 = Dikoma C | authorlink10 =
| 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 =
| doi = 10.1016/j.jns.2017.02.046
}}
</ref>
<ref name="Shan2016">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
<ref name="Zinn, 2018">{{Citation
| last1 = Zinn | first1 = Mark A. | authorlink1 = Mark Zinn
| last2 = Zinn | first2 = Marcie L. | authorlink2 = Marcie Zinn
| last3 = Valencia | first3 = Ian | authorlink3 = Ian Valencia
| last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason
| last5 = Montoya | first5 = Jose G. | authorlink5 = Jose Montoya
| title = Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome
| journal = Biological Psychology | volume = 136 | issue = 1 | page = 87-99
| date = 2018
| pmid =
| doi = 10.1016/j.biopsycho.2018.05.016
}}
</ref>
</references>
[[Category:Neurology]]
[[Category:Central nervous system]]
[[Category:Anatomy]]

Brain

2020-12-04T11:28:27Z

Spoonface:Study on Tarvlov cysts in ME/CFS patients

[[File:Brain diagram CNS.jpg|400px|thumb|Diagram of Brain<ref>{{Cite web|url=https://cnx.org/contents/GFy_h8cu@11.5:JOhgnBan@4/The-Central-Nervous-System|title=The Central Nervous System|last=|first=|date=29 September 2018|website=OpenStax Biology|archive-url=|archive-date=|dead-url=|access-date=29 September 2018}}</ref> License: CC-BY-4.0|alt=Diagram of brain showing Corpus callosum, cerebral cortex, cerebellum, brainsteam, amydala, thalamus, basal ganglia]]
The '''brain''' is an organ that serves as the center of the [[nervous system]] in all vertebrate and most invertebrate animals. The brain is located in the head, usually close to the sensory organs for senses such as vision. It is divided into three parts: the [[brainstem]], cerebellum and cerebrum. The brain and spinal cord make up the [[central nervous system]] (CNS).

The brain and [[spinal cord]] have their own [[immune system]].<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2019/02/190219132853.htm|title=Scientists create new map of brain's immune system|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Feb 19, 2019|website=ScienceDaily|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref> Tissue-resident macrophages, known as [[microglia]], are a part of that immune system.<ref>{{Cite web|title=Brain immune system is key to recovery from motor neuron degeneration: Results in study point to new approaches for ALS therapy|url=https://www.sciencedaily.com/releases/2018/02/180220143439.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Feb 20, 2018|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>

The brain also has its own [[lymphatic system]] which links directly to the blood-borne [[immune system]].<ref>{{Cite web|url=https://www.scientificamerican.com/article/important-link-between-the-brain-and-immune-system-found/|title=Important Link between the Brain and Immune System Found|last=Stetka|first=Bret|authorlink=|last2=|first2=|authorlink2=|date=Jul 21, 2015|website=Scientific American|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-03-31}}</ref>

Injury to the brain or [[spinal cord]], such as those caused by stroke or [[trauma]], result in a considerable weakening of the immune system.<ref>{{Cite web|title=An interconnection between the nervous and immune system: Neuroendocrine reflex triggers infections|url=https://www.sciencedaily.com/releases/2017/09/170919102530.htm|website=ScienceDaily|access-date=2019-03-31|language=en|date=Sep 29, 2017|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</ref>
==ME/CFS ==

<div role="note" class="hatnote navigation-not-searchable">''Main article: [[Neurology of ME/CFS]]''</div>

=== Anatomical changes ===
Significant changes in white and gray matter volumes have frequently been found in patients with ME/CFS but no consistent pattern has been found.<ref name="Shan2016" /><ref name="JaimeS20160505" /><ref name="Goldman20141028">{{citation
| last1 = Goldman | first1 = Bruce | authorlink1 =
| title = Study finds brain abnormalities in chronic fatigue patients
| journal = Stanford Medicine News Center
| date = 2014-10-28
| url = http://med.stanford.edu/news/all-news/2014/10/study-finds-brain-abnormalities-in-chronic-fatigue-patients.html
}}</ref><ref name="Zeineh2014">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref><ref name="Puri, 2012">{{Citation
| last1 = Puri | first1 = BK | authorlink1 = Basant Puri
| last2 = Jakeman | first2 =PM | authorlink2 =
| last3 = Agour | first3 = M | authorlink3 =
| last4 = Gunatilake | first4 = KDR | authorlink4 =
| last5 = Fernando | first5 = KAC | authorlink5 =
| last6 = Gurusinghe | first6 = AI | authorlink6 =
| last7 = Treasaden | first7 = IH | authorlink7 =
| last8 = Waldman | first8 = AD | authorlink8 =
| last9 = Gishen | first9 = P | authorlink9 =
| title = Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study
| journal = British Journal of Radiology | volume = 85 | issue = 1015 | page = e270-3
| date = 2012
| pmid =
| doi = 10.1259/bjr/93889091
}}</ref>

{| class="wikitable"
!Year
!Authors
!N
!Criteria
!Findings
!Ref
|-
|2004
|Okada, et al
|16
|
|Reduced gray-matter volume in the bilateral prefrontal cortex. Volume reduction in the right prefrontal cortex correlated with fatigue severity.
|<ref>{{Cite journal|last=Okada|first=Tomohisa|last2=Tanaka|first2=Masaaki|last3=Kuratsune|first3=Hirohiko|last4=Watanabe|first4=Yasuyoshi|last5=Sadato|first5=Norihiro|date=2004-10-04|title=Mechanisms underlying fatigue: a voxel-based morphometric study of chronic fatigue syndrome|url=https://doi.org/10.1186/1471-2377-4-14|journal=BMC Neurology|volume=4|issue=1|pages=14|doi=10.1186/1471-2377-4-14|issn=1471-2377|pmc=PMC524491|pmid=15461817}}</ref>
|-
|2016
|Shan, et al
|
|Fukuda & CCC
|Decreases in [[white matter]], [[gray matter]] and blood volume deficits
|<ref name="Shan20162">{{citation
| last1 = Shan | first1 = ZY | authorlink1 = Zack Shan
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
|-
|2012
|Basant Puri, et al
|
|
|Reduced grey matter volume in the occipital lobes, the right angular gyrus and the posterior division of the left parahippocampal gyrus.
|<ref name="Puri, 2012" />
|-
|2014
|Zeineh, et al
|
|
|Diminished white matter, white matter abnormalities in the right hemisphere.
|<ref name="Zeineh2014" />
|}

=== Blood flow ===
Several studies have ME/CFS patients have found evidence of reduced cerebral blood flow,<ref name="Natelson, 2017" /><ref name=":3" /><ref name=":10" /><ref>{{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=9–11|doi=10.1016/j.jns.2010.11.018|issn=0022-510X}}</ref><ref name=":11">{{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=83–86|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=767–772|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=222–226|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=50S–53S|doi=10.1016/S0002-9343(98)00175-2|issn=0002-9343}}</ref> including the [[brainstem]]<ref name=":3" /><ref name=":10" /> and cerebral cortex.<ref name=":11" />

A 1995 study found hypoperfusion (reduced blood flow) to the brainstem in patients with ME/CFS.<ref name=":3">{{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=767–773|issn=1460-2725|pmid=8542261}}</ref> In 2011, a study of brain involvement in CFS found "a strong correlation" between brainstem gray matter volume and pulse pressure, "suggesting impaired cerebrovascular autoregulation."<ref name=":10">{{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=1302–1312|doi=10.1002/nbm.1692|issn=1099-1492|pmc=PMC4369126|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=50–58|doi=10.1016/j.cnp.2020.01.003|issn=2467-981X}}</ref>

=== Metabolism ===
A 2003 study of [[Brain|cerebral]] [[glucose]] metabolism in 26 patients with [[chronic fatigue syndrome]] via 18-fluorodeoxyglucose positron emission tomography (FDG-PET) found evidence of hypometabolism (reduced glucose consumption) in approximately half of patients.<ref>{{Cite journal|title=Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome|url=https://jnnp.bmj.com/content/74/7/922|journal=Journal of Neurology, Neurosurgery & Psychiatry|date=2003-07-01|issn=0022-3050|pmid=12810781|pages=922–928|volume=74|issue=7|doi=10.1136/jnnp.74.7.922|language=en|first=P.|last=Bartenstein|first2=U. T.|last2=Egle|first3=M.|last3=Schreckenberger|first4=J.|last4=Hardt|first5=W. A.|last5=Nix|first6=T.|last6=Siessmeier}}</ref> A 1998 PET study also found evidence of reduced metabolism in 18 patients.<ref>{{Cite journal|last=Tirelli|first=Umberto|last2=Chierichetti|first2=Franca|last3=Tavio|first3=Marcello|last4=Simonelli|first4=Cecilia|last5=Bianchin|first5=Gianluigi|last6=Zanco|first6=Pierluigi|last7=Ferlin|first7=Giorgio|date=1998-09-28|title=Brain positron emission tomography (PET) in chronic fatigue syndrome: preliminary data|url=http://www.sciencedirect.com/science/article/pii/S000293439800179X|journal=The American Journal of Medicine|volume=105|issue=3, Supplement 1|pages=54S–58S|doi=10.1016/S0002-9343(98)00179-X|issn=0002-9343}}</ref>

Patients with ME/CFS have also been found to have lower brain glutathione<ref name="Natelson, 2017" /> and higher brain ventricular lactate.<ref name="Natelson, 2017" />

Abnormal distribution of acetyl-L-carnitine uptake, which is one of the biochemical markers of chronic fatigue syndrome, in the prefrontal cortex.{{Citation needed|reason=clarify}}

=== Inflammation ===
{{Main article|page_name=Neuroinflammation}}

Whole-brain MRS markers of neuroinflammation have been found in ME/CFS.<ref name=":02">{{Cite web|url=https://link.springer.com/epdf/10.1007/s11682-018-0029-4?|title=Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy|last=|first=|authorlink=Christina Mueller|last2=|first2=|authorlink2=Joanne Lin|date=2019|website=link.springer.com|doi=10.1007/s11682-018-0029-4|archive-url=|archive-date=|dead-url=|access-date=2019-01-17|authorlink3=Sulaiman Sheriff|authorlink4=Andrew Maudsley|authorlink5=Jarred Younger}}</ref> fMRI images document neuroinflammation.<ref name="Zeineh20143">{{citation
| last1 = Zeineh | first1 = Michael M | authorlink1 = Michael Zeineh
| last2 = Kang | first2 = James | authorlink2 = James Kang
| last3 = Atlas | first3 = Scott W | authorlink3 = Scott Atlas
| last4 = Raman | first4 = Mira M | authorlink4 = Mira Raman
| last5 = Reiss | first5 = Allan L | authorlink5 = Allan Reiss
| last6 = Norris | first6 = Jane L | authorlink6 = Jane Norris
| last7 = Valencia | first7 = Ian | authorlink7 = Ian Valencia
| last8 = Montoya | first8 = Jose G | authorlink8 = Jose Montoya
| display-authors = 3
| title = Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome
| journal = Radiology | volume = 274| issue = 2| pages = 517–526
| date = 2014-10-29
| doi = 10.1148/radiol.14141079
| url = http://pubs.rsna.org/doi/abs/10.1148/radiol.14141079
}}</ref>

In 2014, A Japanese [[positron emission tomography]] (PET) study looked at [[neuroinflammation]] in nine patients with ME/CFS and ten controls. They measured a protein expressed by activated [[microglia]], and found that values in the [[cingulate cortex]], [[hippocampus]], [[amygdala]], [[thalamus]], [[midbrain]], and [[pons]] were 45%–199% higher in ME/CFS patients than in healthy controls. The values in the amygdala, thalamus, and midbrain positively correlated with cognitive impairment score, the values in the cingulate cortex and thalamus positively correlated with pain score, and the value in the hippocampus positively correlated with depression score.<ref name="Nakatomi2014">{{citation
| last1 = Nakatomi | first1 = Yasuhito | authorlink1 =
| last2 = Mizuno | first2 = Kei | authorlink2 =
| last3 = Ishii | first3 = Akira | authorlink3 =
| last4 = Wada | first4 = Yasuhiro | authorlink4 =
| last5 = Tanaka | first5 = Masaaki | authorlink5 =
| last6 = Tazawa | first6 = Shusaku | authorlink6 =
| last7 = Onoe | first7 = Kayo | authorlink7 =
| last8 = Fukuda | first8 = Sanae | authorlink8 =
| last9 = Kawabe | first9 = Joji | authorlink9 =
| last10 = Takahashi | first10= Kazuhiro | authorlink10=
| last11 = Kataoka | first11= Yosky | authorlink11=
| last12 = Shiomi | first12= Susumu | authorlink12=
| last13 = Yamaguti | first13= Kouzi | authorlink13=
| last14 = Inaba | first14= Masaaki | authorlink14=
| last15 = Kuratsune | first15= Hirohiko | authorlink15=
| last16 = Watanabe | first16= Yasuyoshi | authorlink16= Yasuyoshi Watanabe
| display-authors = 3
| title = Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An ¹¹C-(R)-PK11195 PET Study
| journal = Journal of Nuclear Medicine | volume = 2014 Jun;55(6) | page = 945-50
| date = 2014-03-24
| pmid = 24665088 | doi = 10.2967/jnumed.113.131045
| url = http://jnm.snmjournals.org/content/55/6/945.long
}}</ref><ref name="Tuller20141124NYT">{{citation
| last1 = Tuller | first1 = David | authorlink1 = David Tuller
| title = Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder
| journal = NY Times
| date = 2014-11-24
| url = http://well.blogs.nytimes.com/2014/11/24/brains-of-people-with-chronic-fatigue-syndrome-offer-clues-about-disorder/?_r=0
}}</ref>

2019, [[Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy (2019) Mueller, et al|Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: assessment with whole-brain magnetic resonance spectroscopy]], Mueller, et al.<ref name=":022" /><blockquote>This study is the first to investigate whole-brain MRS markers of neuroinflammation in ME/CFS. We report [[metabolite]] and temperature abnormalities in ME/CFS patients in widely distributed brain areas, suggesting ME/CFS is driven by diffuse pathophysiological processes affecting the whole brain, rather than regionally limited, which is consistent with the heterogeneity of its clinical symptoms. Our findings add support to the hypothesis that ME/CFS is the result of chronic, low-level neuroinflammation. While the whole-brain results are preliminary, we note that they largely agree with past publications that use MRS in ME/CFS. These results should be replicated in future studies with larger samples to further establish the profile of pathophysiological abnormalities in the brains of ME/CFS patients. Ultimately, the development of sensitive MRI markers of ME/CFS could supplement clinical tests to help guide treatment decisions.<ref name=":022" /></blockquote>

Several neurochemicals have been studied in relation to ME patients. Myo-inositol is thought to be involved in astrocyte function (Albrecht et al. 2016) and trended to be higher in ME patients compared to controls.<ref name=":5">{{Cite journal|last=Brooks|first=J. C.|last2=Roberts|first2=N.|last3=Whitehouse|first3=G.|last4=Majeed|first4=T.|date=Nov 2000|title=Proton magnetic resonance spectroscopy and morphometry of the hippocampus in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11144799|journal=The British Journal of Radiology|volume=73|issue=875|pages=1206–1208|doi=10.1259/bjr.73.875.11144799|issn=0007-1285|pmid=11144799}}</ref>

N-acetylacetate (NAA) shows neuron density, which has been found in other neurological disorders<ref name=":2">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Granziera|first2=Cristina|last3=Hooker|first3=Jacob M.|last4=Loggia|first4=Marco L.|date=2016-04-20|title=In Vivo Imaging of Human Neuroinflammation|url=https://www.ncbi.nlm.nih.gov/pubmed/26985861|journal=ACS chemical neuroscience|volume=7|issue=4|pages=470–483|doi=10.1021/acschemneuro.6b00056|issn=1948-7193|pmc=5433433|pmid=26985861}}</ref>and has been shown to be lower in ME patients,<ref name=":4">{{Cite journal|last=Chaudhuri|first=A.|last2=Condon|first2=B. R.|last3=Gow|first3=J. W.|last4=Brennan|first4=D.|last5=Hadley|first5=D. M.|date=2003-02-10|title=Proton magnetic resonance spectroscopy of basal ganglia in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12598734|journal=Neuroreport|volume=14|issue=2|pages=225–228|doi=10.1097/01.wnr.0000054960.21656.64|issn=0959-4965|pmid=12598734}}</ref><ref name=":5" />but this was not found in all studies.<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=Nov 2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861}}</ref><ref name=":6">{{Cite journal|last=Tomoda|first=A.|last2=Miike|first2=T.|last3=Yamada|first3=E.|last4=Honda|first4=H.|last5=Moroi|first5=T.|last6=Ogawa|first6=M.|last7=Ohtani|first7=Y.|last8=Morishita|first8=S.|date=Jan 2000|title=Chronic fatigue syndrome in childhood|url=https://www.ncbi.nlm.nih.gov/pubmed/10761837|journal=Brain & Development|volume=22|issue=1|pages=60–64|issn=0387-7604|pmid=10761837}}</ref>

[[Choline]] is linked to activation of glia, loss of energy and expression of macrophages in the brain<ref name=":2" />and has been shown to change compared to controls.<ref name=":4" /><ref name=":5" /><ref name=":6" /><ref>{{Cite journal|last=Puri|first=B. K.|last2=Agour|first2=M.|last3=Gunatilake|first3=K. D. R.|last4=Fernando|first4=K. a. C.|last5=Gurusinghe|first5=A. I.|last6=Treasaden|first6=I. H.|date=Nov 2009|title=An in vivo proton neurospectroscopy study of cerebral oxidative stress in myalgic encephalomyelitis (chronic fatigue syndrome)|url=https://www.ncbi.nlm.nih.gov/pubmed/19906518|journal=Prostaglandins, Leukotrienes, and Essential Fatty Acids|volume=81|issue=5-6|pages=303–305|doi=10.1016/j.plefa.2009.10.002|issn=1532-2823|pmid=19906518}}</ref>

Lactate increases when more energy is being expended and has been shown to be higher than controls,<ref name=":7">{{Cite journal|last=Mathew|first=Sanjay J.|last2=Mao|first2=Xiangling|last3=Keegan|first3=Kathryn A.|last4=Levine|first4=Susan M.|last5=Smith|first5=Eric L. P.|last6=Heier|first6=Linda A.|last7=Otcheretko|first7=Viktor|last8=Coplan|first8=Jeremy D.|last9=Shungu|first9=Dikoma C.|date=Apr 2009|title=Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: an in vivo 3.0 T (1)H MRS imaging study|url=https://www.ncbi.nlm.nih.gov/pubmed/18942064|journal=NMR in biomedicine|volume=22|issue=3|pages=251–258|doi=10.1002/nbm.1315|issn=0952-3480|pmid=18942064}}</ref><ref>{{Cite journal|last=Shungu|first=Dikoma C.|last2=Weiduschat|first2=Nora|last3=Murrough|first3=James W.|last4=Mao|first4=Xiangling|last5=Pillemer|first5=Sarah|last6=Dyke|first6=Jonathan P.|last7=Medow|first7=Marvin S.|last8=Natelson|first8=Benjamin H.|last9=Stewart|first9=Julian M.|date=Sep 2012|title=Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology|url=https://www.ncbi.nlm.nih.gov/pubmed/22281935|journal=NMR in biomedicine|volume=25|issue=9|pages=1073–1087|doi=10.1002/nbm.2772|issn=1099-1492|pmc=3896084|pmid=22281935}}</ref><ref name=":8">{{Cite journal|last=Natelson|first=Benjamin H.|last2=Vu|first2=Diana|last3=Coplan|first3=Jeremy D.|last4=Mao|first4=Xiangling|last5=Blate|first5=Michelle|last6=Kang|first6=Guoxin|last7=Soto|first7=Eli|last8=Kapusuz|first8=Tolga|last9=Shungu|first9=Dikoma C.|date=2017|title=Elevations of Ventricular Lactate Levels Occur in Both Chronic Fatigue Syndrome and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/29308330|journal=Fatigue: Biomedicine, Health & Behavior|volume=5|issue=1|pages=15–20|doi=10.1080/21641846.2017.1280114|issn=2164-1846|pmc=5754037|pmid=29308330}}</ref><ref name=":9">{{Cite journal|last=Murrough|first=James W.|last2=Mao|first2=Xiangling|last3=Collins|first3=Katherine A.|last4=Kelly|first4=Chris|last5=Andrade|first5=Gizely|last6=Nestadt|first6=Paul|last7=Levine|first7=Susan M.|last8=Mathew|first8=Sanjay J.|last9=Shungu|first9=Dikoma C.|date=Jul 2010|title=Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: comparison with major depressive disorder|url=https://www.ncbi.nlm.nih.gov/pubmed/20661876|journal=NMR in biomedicine|volume=23|issue=6|pages=643–650|doi=10.1002/nbm.1512|issn=1099-1492|pmid=20661876}}</ref>and significantly differs from lactate levels in people with psychological disorders.<ref name=":7" /><ref name=":9" />Both ME patients and [[fibromyalgia]] patients were found to have similar levels of elevated lactate, so more tests would be needed to differentiate the two.<ref name=":8" />

Though contrasts were found between ME people and controls in many of these [[Diagnostic biomarker|biomarker]] studies, researchers are not sure what the changes mean.

=== Electrical activity ===
2016, A qEEG/LORETA study of nine controls and nine CFS patients (per [[DePaul Symptom Questionnaire]] (DSQ) and [[Canadian Consensus Criteria]] (CCC) definitions), found significantly decreased eLORETA source analysis oscillations in the occipital, parietal, posterior cingulate, and posterior temporal lobes in Alpha and Alpha-2. This research suggests that "disruptions in these regions and networks could be a neurobiological feature of the disorder, representing underlying neural dysfunction."<ref name="Zinn2016P2">{{Citation
| last1 = Zinn | first1 = Marcie | authorlink1 = Marcie Zinn
| last2 = Zinn | first2 = Mark | authorlink2 = Mark Zinn
| last3 = Jason | first3 = Leonard | authorlink3 = Leonard Jason
| title = Intrinsic Functional Hypoconnectivity in Core Neurocognitive Networks Suggests Central Nervous System Pathology in Patients with Myalgic Encephalomyelitis: A Pilot Study
| journal = Applied Psychophysiology and Biofeedback | volume = 41 | issue = 3 | page = 283-300
| date = 2016
| pmid = 26869373
| doi = 10.1007/s10484-016-9331-3
}}</ref>

2016, A qEEG/LORETA study of one CFS patient (per DSQ and CCC definitions), found deregulation of the functional connectivity networks. This may explain the common symptom of perceived cognitive deficits such as slow thinking, difficulty in reading comprehension, reduced learning and memory abilities and an overall feeling of being in a “[[Brain fog|fog]]".

<ref name=":132">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref> [[File:CLROA-2-110-F1.gif|850px|thumb|center|Figure 1: Results of LORETA current source density in a case with CFS showing widespread decreased current density for delta at 2 Hz and beta (12- 15 Hz) demonstrating a global reduction in brain functioning (blue). The higher frequencies (beta) have been shown to be a function of delta frequencies. In other words, local oscillations are under constant influence of global brain dynamics (Buzsaki, 2006).<ref name=":13">{{Cite web|url=https://www.sciforschenonline.org/journals/clinical-research/CLROA-2-110.php|title=qEEG / LORETA in Assessment of Neurocognitive Impairment in a Patient with Chronic Fatigue Syndrome: A Case Report|last=dr.marcie.zinn@gmail.com|first=Zinn ML, DePaul University, Center for Community Research, Chicago, IL, Tel/ Fax: (773) 325-4923; E-mail:|date=2016|website=www.sciforschenonline.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-28|last2=Zinn|first2=Mark A.|last3=Jason|first4=|first3=Leonard|issn=2469-6714|publisher=SciForschen|doi=10.16966/2469-6714.110}}</ref>|link=https://www.me-pedia.org/wiki/File:CLROA-2-110-F1.gif]]

===T2 Hyperintensities in MRI===
{{bookmark|T2 hyperintensity}}
[[File:T2hyperintensitiesVRS.jpg|400px|thumb|MRI image with small white T2 hyperintensities, which are labelled as "Virchow-Robin spaces". Use allowed for educational purposes, courtesy of radiologyassistant.nl]]
Possible white matter abnormalities of unknown etiology are found on MRIs of some [[ME/CFS]] patients.<ref name=":12">{{Cite journal|last=Natelson|first=B. H.|last2=Cohen|first2=J. M.|last3=Brassloff|first3=I.|last4=Lee|first4=H. J.|date=1993-12-15|title=A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8138812|journal=Journal of the Neurological Sciences|volume=120|issue=2|pages=213–217|doi=10.1016/0022-510x(93)90276-5|issn=0022-510X|pmid=8138812}}</ref><ref name=":14">{{Cite journal|last=Lange|first=G.|last2=DeLuca|first2=J.|last3=Maldjian|first3=J. A.|last4=Lee|first4=H.|last5=Tiersky|first5=L. A.|last6=Natelson|first6=B. H.|date=1999-12-01|title=Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10567042|journal=Journal of the Neurological Sciences|volume=171|issue=1|pages=3–7|doi=10.1016/s0022-510x(99)00243-9|issn=0022-510X|pmid=10567042}}</ref> These are identified by T2 hyperintensities, which might indicate lesions or abnormally dilated Virchow-Robin spaces.<ref>{{Cite journal|last=Kwee|first=Robert M.|last2=Kwee|first2=Thomas C.|date=2007-07-01|title=Virchow-Robin Spaces at MR Imaging|url=https://pubs.rsna.org/doi/full/10.1148/rg.274065722|journal=RadioGraphics|volume=27|issue=4|pages=1071–1086|doi=10.1148/rg.274065722|issn=0271-5333}}</ref>
* 1993, A comparison of brain MRI scans from 52 CFS patients and 52 controls found that 27% of CFS patients had findings considered abnormal, while only 2% of controls had findings considered abnormal. Abnormalities included T2 hyperintensities and ventricular enlargement.<ref name=":12" />
* 1999, A comparison of brain MRI scans from 39 CFS patients and 19 controls found that the 21 CFS patients who did not have a psychiatric diagnosis had significantly more T2 hyperintensities, compared to either controls or the 18 CFS patients with a psychiatric diagnosis.<ref name=":14" />
Since T2 hyperintensities are found in many different neurological conditions, some neurologists consider them to be diagnostically insignificant. Others point out that perhaps they should not be ignored, as they are correlated with cognitive disability and poor motor function.<ref>{{Cite journal|last=Jeong|first=Eun Hye|last2=Lee|first2=Yong Joo|last3=Kim|first3=Sang Joon|last4=Lee|first4=Jae-Hong|date=2015|title=Is the Severity of Dilated Virchow-Robin Spaces Associated with Cognitive Dysfunction?|url=http://dx.doi.org/10.12779/dnd.2015.14.3.114|journal=Dementia and Neurocognitive Disorders|volume=14|issue=3|pages=114|doi=10.12779/dnd.2015.14.3.114|issn=1738-1495}}</ref><ref>{{Cite journal|last=Sachdev|first=P. S.|last2=Wen|first2=W.|last3=Christensen|first3=H.|last4=Jorm|first4=A. F.|date=2005-03-01|title=White matter hyperintensities are related to physical disability and poor motor function|url=https://jnnp.bmj.com/content/76/3/362|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=76|issue=3|pages=362–367|doi=10.1136/jnnp.2004.042945|issn=0022-3050|pmid=15716527}}</ref>

=== Tarlov cysts ===
A study of 197 ME/CFS patients found that the prevalance of Tarlov cysts was three times higher in ME/CFS patients than the general population, at 39%.<ref>{{Cite journal|last=Hulens|first=Mieke|last2=Bruyninckx|first2=Frans|last3=Dankaerts|first3=Wim|last4=Rasschaert|first4=Ricky|last5=De Mulder|first5=Peter|last6=Stalmans|first6=Ingeborg|last7=Vansant|first7=Greet|last8=Bervoets|first8=Chris|date=2020-12-01|title=High Prevalence of Perineural Cysts in Patients with Fibromyalgia and Chronic Fatigue Syndrome|url=https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaa410/6015822|journal=Pain Medicine|language=en|pages=pnaa410|doi=10.1093/pm/pnaa410|issn=1526-2375}}</ref>

Tarlov cyst patients often complain about widespread pain and fatigue.

The authors conclude:<blockquote>This observation supports the hypothesis that STCs, FM, and CFS may share the same pathophysiological mechanism, i.e., moderately increased cerebrospinal fluid pressure, causing irritation of neurons and axons in dorsal root ganglia</blockquote>

== '''UNSORTED/unincorporated articles''' ==
*more abnormal spinal fluids<ref name="Natelson, 2017" />, and psychiatric comorbidity does not influence any of these potential biological markers of [[CFS]], <ref name="Natelson, 2017" />
*a subgroup of [[CFS]] patients with brain abnormalities may have an underlying encephalopathy producing their illness.<ref name="Natelson, 2017" />

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)|''Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder''By David Tuller - New York Times: Well]]<ref name="Tuller20141124NYT" />

*2016, One six year longitudinal study found that [[Chronic Fatigue Syndrome]] (CFS) (meeting the [[Fukuda criteria]] and [[Canadian Consensus Criteria]]) is associated with decreases in [[white matter]], [[gray matter]] and blood volume deficits in the brain as compared to healthy controls.<ref name="Shan20163">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik| first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>

*2017, A study, using segmented anatomical [[Magnetic resonance imaging|MRI]] brain scans showed that, adjusting for total [[intracranial volume]], [[CFS]] patients (as per Fukuda diagnostic criteria) had larger gray matter volume and lower white matter volume. The increased gray matter volume was predominantly found in the [[amygdala]] and [[insula]] cortex. The decreased white matter was predominantly found in the midbrain and temporal lobe.<ref name="Finkelmeyer, 20172">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}</ref>
*2020, Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Washington2020">{{Cite journal|last=Washington|first=Stuart D.|author-link=|last2=Rayhan|first2=Rakib U.|author-link2=Rakib Rayhan|last3=Garner|first3=Richard|author-link3=|last4=Provenzano|first4=Destie|author-link4=|last5=Zajur|first5=Kristina|author-link5=|last6=Addiego|first6=Florencia Martinez|author-link6=|last7=VanMeter|first7=John W.|last8=Baraniuk|first8=James N.|author-link8=James Baraniuk|date=2020-07-01|title=Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074|journal=Brain Communications|language=en|volume=2|issue=2|pages=|doi=10.1093/braincomms/fcaa070|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074 (Full text)] - see [[:Category:Images|images folder]]

== Chronic pain ==
In 2015, Loggia’s team<ref name=":1">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> successfully imaged [[neuroinflammation]]— specifically the activation of glial cells — in the brains of patients with [[chronic pain]] using a new imaging approach — a combination of [[magnetic resonance imaging]] (MRI) and [[positron emission tomography]] (PET), or MR/PET scanning.<ref name=":03">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref> MR/PET blends the structural and functional detail of tissues that an MRI gives with the sensitivity and [[metabolic]] function that PET scans provide.<ref name=":04">{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>Specifically, PET scanning detects the radiation given off by a substance injected into a person, called a radiotracer, following its distribution throughout the body.<ref name=":04" />

==Notable studies==

*2014, [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)]]
*2016, Relative increase in choline in the occipital cortex in chronic fatigue syndrome<ref>{{Cite journal|last=Puri|first=B. K.|last2=Counsell|first2=S. J.|last3=Zaman|first3=R.|last4=Main|first4=J.|last5=Collins|first5=A. G.|last6=Hajnal|first6=J. V.|last7=Davey|first7=N. J.|date=2002|title=Relative increase in choline in the occipital cortex in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12197861|journal=Acta Psychiatrica Scandinavica|volume=106|issue=3|pages=224–226|issn=0001-690X|pmid=12197861|via=}}</ref>
*2017, CNS findings in chronic fatigue syndrome and a neuropathological case report<ref name="Ferrero, 2017" />
*2017, Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study<ref name="Finkelmeyer, 2017" />
*2018, Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients<ref>{{Cite journal|last=Staud|first=Roland|author-link=Roland Staud|last2=Robinson|first2=Michael E.|author-link2=|last3=Letzen|first3=Janelle E.|author-link3=|last4=Boissoneault|first4=Jeff|author-link4=|last5=Sevel|first5=Landrew S.|author-link5=|date=2018-08-01|title=Structural brain changes versus self-report: machine-learning classification of chronic fatigue syndrome patients|url=https://link.springer.com/article/10.1007/s00221-018-5301-8|journal=Experimental Brain Research|language=en|volume=236|issue=8|pages=2245–2253|doi=10.1007/s00221-018-5301-8|issn=1432-1106|pmc=|pmid=29846797|quote=|via=}}</ref> [https://link.springer.com/article/10.1007/s00221-018-5301-8 (Abstract)]
*2018, Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with [[chronic fatigue syndrome]]<ref name="Zinn, 2018" /> [https://www.sciencedirect.com/science/article/pii/S0301051118304071 (Abstract)]
*2018, Brain function characteristics of [[chronic fatigue syndrome]]: A task fMRI study<ref name=":0">{{Cite journal|last=Shan|first=Zack Y.|last2=Finegan|first2=Kevin|last3=Bhuta|first3=Sandeep|last4=Ireland|first4=Timothy|last5=Staines|first5=Donald R.|last6=Marshall-Gradisnik|first6=Sonya M.|last7=Barnden|first7=Leighton R.|date=2018-01-01|others=National Centre for Neuroimmunology and Emerging Diseases; Medical Imaging Dept., Gold Coast Hosp.|title=Brain function characteristics of chronic fatigue syndrome: A task fMRI study|url=https://www.sciencedirect.com/science/article/pii/S2213158218301347|journal=NeuroImage: Clinical|language=en|volume=19|pages=279–286|doi=10.1016/j.nicl.2018.04.025|issn=2213-1582|via=Elsevier}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218301347 (Full Text)]

[[File:Brain function characteristics of chronic fatigue syndrome A task fMRI study (2018).jpeg|400px|thumb|center|Brain function characteristics of chronic fatigue syndrome: A task fMRI study (2018) <ref name=":0" /> ]]

*2018, Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Nakatomi, 2018" />
*2018, Hyperintense sensorimotor T1 spin echo [[MRI]] is associated with brainstem abnormality in [[chronic fatigue syndrome]]<ref>{{Cite journal|last=Barnden|first=Leighton R.|last2=Shan|first2=Zack Y.|last3=Staines|first3=Donald R.|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|last6=Ireland|first6=Timothy|last7=Bhuta|first7=Sandeep|date=2018|title=Hyperintense sensorimotor T1 spin echo MRI is associated with brainstem abnormality in chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S2213158218302237|journal=NeuroImage: Clinical|volume=20|pages=102-109|doi=10.1016/j.nicl.2018.07.011|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158218302237 (Full Text)]
*2018, Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging<ref>{{Cite journal|last=Kimura|first=Yukio|last2=Sato|first2=Noriko|last3=Ota|first3=Miho|last4=Shigemoto|first4=Yoko|last5=Morimoto|first5=Emiko|last6=Enokizono|first6=Mikako|last7=Matsuda|first7=Hiroshi|last8=Shin|first8=Isu|last9=Amano|first9=Keiko|date=2018-11-14|title=Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247|journal=Journal of Magnetic Resonance Imaging|language=en|doi=10.1002/jmri.26247|issn=1053-1807}}</ref> [https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.26247?af=R (Abstract)]

*2019, Intra brainstem connectivity is impaired in chronic fatigue syndrome<ref name="brainconnectivity2019">{{Cite journal|last=Barnden|first=Leighton R|author-link=Leighton Barnden|last2=Shan|first2=Zack Y|author-link2=Zack Shan|last3=Staines|first3=Donald R|author-link3=Donald Staines|last4=Marshall-Gradisnik|first4=Sonya|author-link4=Sonya Marshall-Gradisnik|last5=Finegan|first5=Kevin|author-link5=|last6=Ireland|first6=Timothy|author-link6=|last7=Bhuta|first7=Sandeep|last8=|first8=|date=2019-10-19|title=Intra brainstem connectivity is impaired in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S2213158219303924|journal=NeuroImage: Clinical|volume=24|issue=|pages=102045|doi=10.1016/j.nicl.2019.102045|issn=2213-1582|pmc=|pmid=|access-date=|quote=|via=}}</ref> [https://www.sciencedirect.com/science/article/pii/S2213158219303924 (Full text)]

==Notable studies==
*2016, [https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/ Six year study of abnormal brain changes in chronic fatigue syndrome patients]<ref>{{Cite news|url=https://meaustralia.net/2016/07/12/six-year-study-of-abnormal-brain-changes-in-chronic-fatigue-syndrome-patients/|title=Six year study of abnormal brain changes in chronic fatigue syndrome patients|last=Nimmo|first=Sasha|date=2016-07-12|work=ME Australia|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2016, [http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover A bug in fMRI software could invalidate 15 years of brain research]<ref>{{Cite news|url=http://www.sciencealert.com/a-bug-in-fmri-software-could-invalidate-decades-of-brain-research-scientists-discover|title=A Bug in FMRI Software Could Invalidate 15 Years of Brain Research|last=Crew|first=Bec|date=Jul 6, 2016|work=ScienceAlert|access-date=2018-08-23|archive-url=|archive-date=|dead-url=|language=en-gb}}</ref>
*2016, [http://www.nature.com/nature/journal/vaop/ncurrent/full/nature18933.html A multi-modal parcellation of human cerebral cortex - ''Nature''].<ref>{{Cite journal|last=Glasser|first=Matthew F.|last2=Coalson|first2=Timothy S.|last3=Robinson|first3=Emma C.|last4=Hacker|first4=Carl D.|last5=Harwell|first5=John|last6=Yacoub|first6=Essa|last7=Ugurbil|first7=Kamil|last8=Andersson|first8=Jesper|last9=Beckmann|first9=Christian F.|date=2016-07-20|title=A multi-modal parcellation of human cerebral cortex|url=https://www.nature.com/articles/nature18933|journal=Nature|language=En|volume=536|issue=7615|pages=171–178|doi=10.1038/nature18933|issn=0028-0836}}</ref>An article on this brain imaging mapping research with video appeared in [https://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force?CMP=twt_gu ''The Guardian Science''- Updated map of the human brain hailed as a scientific tour de force]<ref>{{Cite web|url=http://www.theguardian.com/science/2016/jul/20/updated-map-of-the-human-brain-hailed-as-a-scientific-tour-de-force|title=Updated map of the human brain hailed as a scientific tour de force|last=Sample|first=Ian|date=2016-07-20|website=the Guardian|language=en|access-date=2018-08-23}}</ref>and [http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279 ''CNN Health''article - New brain map identifies 97 previously unknown regions].<ref>{{Cite news|url=http://www.cnn.com/2016/07/20/health/new-brain-map/index.html?sr=twcnni072016new-brain-map0712PMVODtopPhoto&linkId=26762279|title=Updated brain map identifies 97 new areas|last=CNN|first=Susan Scutti,|date=Jul 20, 2016|work=CNN|access-date=2018-08-23|archive-url=|archive-date=|dead-url=}}</ref>

*2016, [http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/ Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta]<ref>{{Cite news|url=http://www.meaction.net/2016/02/07/case-study-brain-fog-in-cfs-can-be-seen-in-qeegloreta-analysis/|title=Case Study: "Brain Fog" in CFS can be seen in qEEG/Loreta - #MEAction|last=M|first=Beth|date=2016-02-07|work=#MEAction|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/ Study Identifies the Types of Cognitive Dysfunction That Are Most Prevalent in Fibromyalgia]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/|title=Fibromyalgia Study Identifies Main Types of Patients' Cognitive Dysfunction|last=Pena|first=Amy|date=2018-03-21|work=Fibromyalgia News Today|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*2018, [https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/ Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS)]<ref>{{Cite news|url=https://www.healthrising.org/blog/2018/09/24/brain-fire-neuroinflammation-found-chronic-fatigue-syndrome-me-cfs/|title=Brain on Fire: Widespread Neuroinflammation Found in Chronic Fatigue Syndrome (ME/CFS) - Health Rising|last=Johnson|first=Cort|date=2018-09-24|work=Health Rising|access-date=2018-09-25|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>

*2018, [https://www.youtube.com/watch?v=rxdzaWD5wfU ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study]<ref>{{Cite web|url=https://www.youtube.com/watch?v=rxdzaWD5wfU|title=ME/CFS Involves Brain Inflammation: Results from a Ramsay Pilot Study|date=Dec 14, 2018|access-date=|website=YouTube|last=|first=|authorlink=Jarred Younger|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=|publisher=SolveCFS}}</ref>

*2019, [http://go.solvecfs.org/webmail/192652/97033877/74d435097e87231f24cffe4d9de93da8e3f71c0e077a67417eba10cbd269ccb1 ''Brain Imaging and Behavior'' publication from Dr. Jarred Younger’s SMCI Ramsay pilot s]

==Talks and interviews==

== See also ==
* [[Brainstem]]
* [[Central nervous system]]
* [[Neurology of ME/CFS]]

==Learn more==
*[https://www.cortechslabs.com/neuroquant/tba/ Neuroquant Triage Brain Atrophy Report (MRI)]<ref>{{Cite web|url=https://www.cortechslabs.com/neuroquant/tba/|title=Triage Brain Atrophy Report|last=|first=|date=|website=Cortechs Labs|archive-url=|archive-date=|dead-url=|access-date=}}</ref> - Provides physicians a quick reference and in-depth look on regional and global brain structure volumes, which could occur as a result of a brain injury or in neurodegenerative disease, by providing volume measurements of 44 brain structures for both the right and left hemisphere, total structure – all sorted by lobe and region. With a detailed table of intracranial volume and right, left and total values for normative percentile of ICV. Resulting values are automatically compared to gender and age-appropriate reference distribution.
*[https://www.youtube.com/watch?v=LQ4DlE1Xyd4 2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)]<ref>{{Cite web|url=https://www.youtube.com/watch?v=LQ4DlE1Xyd4|title=2-Minute Neuroscience: Lobes and Landmarks of the Brain Surface (Lateral View)|last=|first=|date=Aug 22, 2014|website=YouTube|publisher=Neuroscientifically Challenged|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

==References==
<references>
<ref name="JaimeS20160505">{{citation
| author = Jaime S | authorlink1 = Jaime S
| title = Progressive Brain Changes in Patients with Chronic Fatigue Syndrome: Are our Brains Starved of Oxygen?
| journal = #MEAction
| date = 2016-05-05
| url = http://www.meaction.net/2016/05/05/progressive-brain-changes-in-patients-with-chronic-fatigue-syndrome-are-our-brains-starved-of-oxygen/
}}</ref>
<ref name="Ferrero, 2017">{{Citation
| last1 = Ferrero | first1 = Kimberly | authorlink1 =
| last2 = Silver | first2 = Mitchell | authorlink2 =
| last3 = Cocchetto | first3 = Alan | authorlink3 =
| last4 = Masliah | first4 = Eliezer | authorlink4 =
| last5 = Langford | first5 = Dianne | authorlink5 =
| title = CNS findings in chronic fatigue syndrome and a neuropathological case report
| journal = Journal of Investigative Medicine| volume = | issue = | page =
| date = 2017
| doi = 10.1136/jim-2016-000390
}}
</ref>
<ref name="Finkelmeyer, 2017">{{Citation
| last1 = Finkelmeyer | first1 = Andreas | authorlink1 = Andreas Finkelmeyer
| last2 = He | first2 = Jiabao | authorlink2 =
| last3 = Maclachlan | first3 = Laura | authorlink3 =
| last4 = Watson | first4 = Stuart | authorlink4 =
| last5 = Gallagher | first5 = Peter | authorlink5 =
| last6 = Newton | first6 = Julia L. | authorlink6 = Julia Newton
| last7 = Blamire | first7 = Andrew M. | authorlink7 =
| title = Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study
| journal = NeuroImage: Clinical | volume = 17 | issue = | page = 24-30
| date = 2018
| pmid = 29021956
| doi = 10.1016/j.nicl.2017.09.024
| url = http://www.sciencedirect.com/science/article/pii/S221315821730236X
}}
</ref>
<ref name="Nakatomi, 2018">{{Citation
| last1 = Nakatomi | first1 = Y | authorlink1 =
| last2 = Kuratsune | first2 = H | authorlink2 =
| last3 = Watanabe | first3 = Y | authorlink3 = Yasuyoshi Watanabe
| title = Neuroinflammation in the Brain of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
| journal = Brain Nerve | volume = 70 | issue = 1 | page = 19-25
| date = 2018
| pmid = 29348371
| doi = 10.11477/mf.1416200945
}}
</ref>
<ref name="Natelson, 2017">{{Citation
| last1 = Natelson | first1 = Benjamin | authorlink1 = Benjamin Natelson
| last2 = Mao | first2 = Xiangling | authorlink2 =
| last3 = Stegner | first3 = Aaron J | authorlink3 =
| last4 = Lange | first4 = Gudrun | authorlink4 = Gudrun Lange
| last5 = Vu | first5 = Diana | authorlink5 =
| last6 = Blate | first6 = Michelle | authorlink6 =
| last7 = Kang | first7 = Guoxin | authorlink7 =
| last8 = Soto | first8 = Eli | authorlink8 =
| last9 = Kapusuz | first9 = Tolga | authorlink9 =
| last10 = Shungu | first10 = Dikoma C | authorlink10 =
| 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 =
| doi = 10.1016/j.jns.2017.02.046
}}
</ref>
<ref name="Shan2016">{{citation
| last1 = Shan | first1 = ZY | authorlink1 =
| last2 = Kwiatek | first2 = R | authorlink2 = Richard Kwiatek
| last3 = Burnet | first3 = R | authorlink3 = Richard Burnet
| last4 = Del Fante | first4 = P | authorlink4 = Peter Del Fante
| last5 = Staines | first5 = DR | authorlink5 = Donald Staines
| last6 = Marshall-Gradisnik | first6 = SM | authorlink6 = Sonya Marshall-Gradisnik
| last7 = Barnden | first7 = LR | authorlink7 = Leighton Barnden
| title = Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study
| journal = Journal of magnetic resonance imaging: JMRI
| date = 2016-04-28
| pmid = 27123773 | doi = 10.1002/jmri.25283
| url = http://onlinelibrary.wiley.com/doi/10.1002/jmri.25283/abstract;jsessionid=070BE1111DE3D52AC62FD00B68E96028.f03t01
}}</ref>
<ref name="Zinn, 2018">{{Citation
| last1 = Zinn | first1 = Mark A. | authorlink1 = Mark Zinn
| last2 = Zinn | first2 = Marcie L. | authorlink2 = Marcie Zinn
| last3 = Valencia | first3 = Ian | authorlink3 = Ian Valencia
| last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason
| last5 = Montoya | first5 = Jose G. | authorlink5 = Jose Montoya
| title = Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome
| journal = Biological Psychology | volume = 136 | issue = 1 | page = 87-99
| date = 2018
| pmid =
| doi = 10.1016/j.biopsycho.2018.05.016
}}
</ref>
</references>
[[Category:Neurology]]
[[Category:Central nervous system]]
[[Category:Anatomy]]

Clivo-axial angle

2020-08-30T18:38:41Z

Spoonface:Updated Bragée/Bertelson reference to peer-reviewed article. Added their definition of CXA

The '''clivo-axial angle''' (CXA) is a measure of the angle between the clivus, a bony part of the base of the skull, and the spine.<ref name=":0">[https://csfinfo.org/files/1613/9665/4797/Final_Booklet_complete.pdf Consensus statement. 2nd International CSF Dynamics Symposium, 2013.] </ref> It is used to aid in the diagnosis of [[craniocervical instability]]. It is sensitive to horizontal instability and characterizes the relationship between the skull, the brainstem, and the odontoid process, including abnormalities due for example, to a compromised [[transverse ligament]].

== Definitions ==
Also called the clivus canal angle, the clivus vertebral angle, the clivus spinal angle or the clivus cervical angle, terms and measurement methodology can vary from study to study and from neurosurgeon to neurosurgeon.<ref name=":4">{{Cite journal|last=Henderson|first=Fraser C.|last2=Henderson|first2=Fraser C.|last3=Wilson|first3=William A.|last4=Mark|first4=Alexander S.|last5=Koby|first5=Myles|date=2018-01-01|title=Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review|url=https://doi.org/10.1007/s10143-017-0830-3|journal=Neurosurgical Review|language=en|volume=41|issue=1|pages=149–163|doi=10.1007/s10143-017-0830-3|issn=1437-2320|pmc=PMC5748419|pmid=28258417}}</ref> In an effort to standardize terminology and measurement, a 2014 consensus statement defined the CXA as "the angle between the clivus line and the posterior axial line."<ref name=":4" /><ref name=":5">Batzdorf U, Henderson F, Rigamonti D (2016) Eds. ''Co-morbitidies that complicate the treatment and outcomes of chiari malformation.'' First edition ed. Chiari Syringomyelia Foundation Inc., Lulu</ref><blockquote>The clivus line is drawn along the lower third of the clivus, from the spheno-occipital synchondrosis to the basion; in the case of basilar invagination, it is drawn from the spheno-occipital synchondrosis to the top of the odontoid process. The posterior axial line is differentiated to reflect either the bone contour of the axis on CT, the so-called ''bone CXA'', or the ligamentous margin of the odontoid—the ''soft tissue CXA''. The soft tissue CXA, necessarily including thickening of the posterior ligament due to pannus, may be more pertinent in identifying possible ventral brainstem compression, and is therefore more representative of the pathology.<ref name=":4" /><ref name=":5" /></blockquote>

== Epidemiology ==
The average CXA in healthy or nonsymptomatic population is estimated to be approximately 150 degrees. Several studies have shown that a CXA lower than 135 degrees, a frequently used cutoff, is uncommon in the healthy population<ref name=":1">{{Cite journal|last=Botelho|first=Ricardo Vieira|last2=Ferreira|first2=Edson Dener Zandonadi|date=Oct 2013|title=Angular craniometry in craniocervical junction malformation|url=https://www.ncbi.nlm.nih.gov/pubmed/23640096|journal=Neurosurgical Review|volume=36|issue=4|pages=603–610; discussion 610|doi=10.1007/s10143-013-0471-0|issn=1437-2320|pmc=3910287|pmid=23640096}}</ref><ref name=":2">{{Cite journal|last=Batista|first=Ulysses C.|last2=Joaquim|first2=Andrei F.|last3=Fernandes|first3=Yvens B.|last4=Mathias|first4=Roger N.|last5=Ghizoni|first5=Enrico|last6=Tedeschi|first6=Helder|date=Apr 2015|title=Computed tomography evaluation of the normal craniocervical junction craniometry in 100 asymptomatic patients|url=https://www.ncbi.nlm.nih.gov/pubmed/25828499|journal=Neurosurgical Focus|volume=38|issue=4|pages=E5|doi=10.3171/2015.1.FOCUS14642|issn=1092-0684|pmid=25828499}}</ref><ref name=":3">{{Cite journal|last=Bundschuh|first=C|last2=Modic|first2=Mt|last3=Kearney|first3=F|last4=Morris|first4=R|last5=Deal|first5=C|date=1988-07-01|title=Rheumatoid arthritis of the cervical spine: surface-coil MR imaging|url=https://www.ajronline.org/doi/abs/10.2214/ajr.151.1.181|journal=American Journal of Roentgenology|volume=151|issue=1|pages=181–187|doi=10.2214/ajr.151.1.181|issn=0361-803X}}</ref> (see table below) and is associated with pathological conditions such as brainstem compression in patients with [[rheumatoid arthritis]].<ref name=":3" /> A consensus statement formed at the second International CSF Dynamics Symposium of the Chiari and Syringomyelia Foundation in 2013, proposed that a CXA lower than 135 degrees could be seen as “potentially pathological.”<ref name=":0" />
{| class="wikitable"
!Study
!Term
!Definition
!Number of healthy persons
!Average CXA
!standard deviation
!Range
|-
|Bothelo & Ferreira (2013)<ref name=":1" />
|Clivo-canal angle (CCA)
|The angle between the line extending from the top of the dorsum sellae to the basion and the line between the inferodorsal portions of C2 to the most superodorsal part of the dens.<ref name=":1" />
|33
|148°
|± 9.8°
|129°-175°
|-
|Batista et al. (2015)<ref name=":2" />
|Clivus-canal angle (CCA)
|Measured as the angle at the intersection of a line extending from the inferior one-third of the clivus and a line extending from the inferodorsal portion of the C-2 vertebral body to the superodorsal part of the dens<ref name=":2" />
|100
|153.6°
|± 7.6°
|132.3°–173.9°
|-
|Bundschuh et al. (1987)<ref name=":3" />
|Cervicomedullary angle
|Angle subtended by lines drawn parallel to the ventral surfaces of the medulla and upper cervical cord<ref name=":3" />
|50
|155.2°
|± 8,7°
|135°-175°
|-
|Asal and Hasan (2018)<ref name=":7" />
|Clivo-axial angle (CAA)
|The angle between the line extending from dorsum sella to basion and the line drawn along the boundary superoposterior and inferoposterior corners of the C2 vertebrae.<ref name=":7" />
|65
|153.66°
|±6.35°
|139.5-169.5
|-
|Nagashima and Kubota (1983)<ref name=":6">{{Cite journal|last=Nagashima|first=C.|last2=Kubota|first2=S.|date=1983|title=Craniocervical abnormalities. Modern diagnosis and a comprehensive surgical approach|url=https://www.ncbi.nlm.nih.gov/pubmed/6674836|journal=Neurosurgical Review|volume=6|issue=4|pages=187–197|issn=0344-5607|pmid=6674836}}</ref>
|Clivo-axial angle (C-A angle)
|The clivus line (line drawn along posterior surface of clivus) and the axis line (line drawn along posterior surface of axis) form the angle.<ref name=":6" />
|41
|158.2°
|± 9.8°
|
|}

=== Gender ===
Women have increased range of motion (change in CXA from flexion to extension) than men.<ref name=":6" />

===ME/CFS ===
A Swedish study of 234 ME/CFS patients meeting the [[Canadian Consensus Criteria]] found an average CXA of f 148 ±10 degrees<ref>{{Cite journal|last=Bragée|first=Björn|last2=Michos|first2=Anastasios|last3=Drum|first3=Brandon|last4=Fahlgren|first4=Mikael|last5=Szulkin|first5=Robert|last6=Bertilson|first6=Bo C.|date=2020-08-28|title=Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.frontiersin.org/article/10.3389/fneur.2020.00828/full|journal=Frontiers in Neurology|volume=11|pages=828|doi=10.3389/fneur.2020.00828|issn=1664-2295}}</ref>, measured as:<blockquote>A straight line was drawn along the caudal edge of the clivus bone, and a second was drawn by extending a straight line along the posterior axial line from the base of the axis to the dens</blockquote>

=== Ehlers-Danlos Syndrome ===
A unpublished study of the CXA in patients with [[Ehlers-Danlos syndrome]] and a control group of patients with cervical spondolysis found that EDS patients had an average CXA of 139.7±10.4 degrees as compared to the control group 148.9±8.4. They also had a greater change in CXA between flexion and extension: 74.6±24.4 in the EDS group vs 39.4±11.3 in controls.<ref>{{Cite journal|last=Casey|first=A. T.|last2=Smith|first2=F.|last3=Davagnanam|first3=I.|last4=Khan|first4=F.|last5=Prezerakos|first5=G. K.|date=2019-03-01|title=FM1-7 Cranio-cervical instability in ehlers-danlos syndrome employing upright, dynamic MR imaging; a comparative study|url=https://jnnp.bmj.com/content/90/3/e22.2|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=90|issue=3|pages=e22–e22|doi=10.1136/jnnp-2019-ABN.69|issn=0022-3050}}</ref>

=== Migraine ===
The clivo-axial angle of 65 patients with [[migraine]] and 65 controls were compared. The mean CXA in the migraine group was 142.65 ± 8.73°, 153.66 ± 6.35° in controls.<ref name=":7">{{Cite journal|last=Şahan|first=Mehmet Hamdi|last2=Asal|first2=Neşe|date=2018-12-01|title=Is there a relationship between migraine disease and the skull base angles?|url=https://dergipark.org.tr/ortadogutipdergisi/issue/40670/411138|journal=Ortadoğu Tıp Dergisi|language=en|volume=10|issue=4|pages=456–470|doi=10.21601/ortadogutipdergisi.411138|quote=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|author-link6=|via=}}</ref>

=== Basilar invagination ===
Bothelo & Ferreira (2013) documented 25 patients with [[basilar invagination]] and found a mean CXA of 120° (range 79°–145°).<ref name=":1" />

== References ==
{{reflist}}
[[Category:Neurology]]

Intracranial hypertension

2020-08-30T18:07:07Z

Spoonface:Updated ME/CFS section following peer review of Bertelson/Bragée

'''Intracranial hypertension''' (IH) is a condition of increased pressure inside the skull.{{Citation needed|reason=|date=22 December 2019}} It results from increases in the volume of the brain, blood or spinal fluid within the fixed volume of the cranium (skull).{{Citation needed|reason=|date=22 December 2019}} These changes can be caused by brain swelling (meningitis or encephalitis), excess cerebrospinal fluid production, poor spinal fluid drainage, excess blood flow to the brain, and poor drainage of blood from the brain.

==Signs and symptoms==
* [[Headache]] (worse when lying down)<ref>{{Cite journal|last=Soler|first=D.|last2=Cox|first2=T.|last3=Bullock|first3=P.|last4=Calver|first4=D. M.|last5=Robinson|first5=R. O.|date=1998-01-01|title=Diagnosis and management of benign intracranial hypertension|url=https://adc.bmj.com/content/78/1/89|journal=Archives of Disease in Childhood|language=en|volume=78|issue=1|pages=89–94|doi=10.1136/adc.78.1.89|issn=0003-9888|pmid=9534686}}</ref>
* Dizziness
* Nausea / vomiting
* Altered vision
* Pulse synchronous [[tinnitus]]
* [[Neck pain|Stiff neck]]
* Back and arm pain<ref name=":3" /><ref name=":4" />
* Pain behind the eyes
* [[Photophobia]]
* Exercise intolerance<ref name=":4">{{Cite news|url=https://rarediseases.org/rare-diseases/idiopathic-intracranial-hypertension/|title=Idiopathic Intracranial Hypertension|work=NORD (National Organization for Rare Disorders)|access-date=2018-11-12|language=en-US}}</ref>
* Memory difficulties
* Back pain, radiculopathy (radiating pain)<ref name=":3" />
The most common sign is [[papilledema]] (swelling of the optic nerve sheath).

==Diagnosis==

There are many tools that can be used in the diagnosis of intracranial hypertension. The most typical method is a lumbar puncture, during which the opening pressure is measured. Opening pressures of 20 H<sub>2</sub>O or greater are considered abnormal in non-obsese people, 25 H<sub>2</sub>O or greater in obese people.

However, as pressure can fluctuate and change with position, a more accurate method is a 24 hour intracranial bolt test. This involves inserting an intracranial pressure monitor directly into the cranium to continuously measure pressure over the course of a day. Normal is 7-15 mm Hg in a supine adult.<ref>{{Cite journal|last=Pickard|first=J. D.|last2=Czosnyka|first2=M.|date=2004-06-01|title=Monitoring and interpretation of intracranial pressure|url=https://jnnp.bmj.com/content/75/6/813|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=75|issue=6|pages=813–821|doi=10.1136/jnnp.2003.033126|issn=0022-3050|pmid=15145991}}</ref>

An MRI can also aid in diagnosis. While generally considered benign, an empty sella can suggest intracranial hypertension, particularly in patients manifesting the symptoms of intracranial hypertension.<ref>{{Cite web|url=https://rarediseases.org/rare-diseases/empty-sella-syndrome/|title=Empty Sella Syndrome|website=NORD (National Organization for Rare Disorders)|language=en-US|access-date=2019-06-22}}</ref> An empty sella is when the sella, a bony space which holds the [[pituitary gland]], appears “empty” (dark/black) on an MRI. This is because, due to high pressure, the space has been filled with cerebrospinal fluid, flattening the pituitary gland. Patients can also have excess spinal fluid in their optic nerve sheath, which can cause pain behind the eyes and papilledema.

Finally, an MR venogram (a type of MRI that uses contrast to visualizes the veins in the brain) can detect bilateral [[transverse venous sinus]] stenosis (TSS), a narrowing of two veins in the back of the head that drain blood from the brain. TSS is found in 83% of cases of intracranial hypertension (compared to 3% of controls).<ref>{{Cite journal|last=Campeau|first=N.|last2=Port|first2=J.|last3=Black|first3=D. F.|last4=Morris|first4=P. P.|date=2017-03-01|title=Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension|url=http://www.ajnr.org/content/38/3/471|journal=American Journal of Neuroradiology|language=en|volume=38|issue=3|pages=471–477|doi=10.3174/ajnr.A5055|issn=0195-6108|pmid=28104635}}</ref> It is not known whether TSS is cause or effect, but there is growing evidence that stenting one of the transverse sinus veins can improve or resolve intracranial hypertension.<ref name=":0">{{Cite journal|last=Higgins|first=J Nicholas P|last2=Owler|first2=Brian K|last3=Cousins|first3=Claire|last4=Pickard|first4=John D|date=2002-01-19|title=Venous sinus stenting for refractory benign intracranial hypertension|url=http://www.sciencedirect.com/science/article/pii/S0140673602074408|journal=The Lancet|volume=359|issue=9302|pages=228–230|doi=10.1016/S0140-6736(02)07440-8|issn=0140-6736}}</ref><ref name=":1">{{Cite journal|last=Pickard|first=J. D.|last2=Sarkies|first2=N.|last3=Owler|first3=B. K.|last4=Cousins|first4=C.|last5=Higgins|first5=J. N. P.|date=2003-12-01|title=Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting|url=https://jnnp.bmj.com/content/74/12/1662|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=74|issue=12|pages=1662–1666|doi=10.1136/jnnp.74.12.1662|issn=0022-3050|pmid=14638886}}</ref><ref name=":2">{{Cite journal|last=Halmagyi|first=G. M.|last2=Owler|first2=B. K.|last3=Hanlon|first3=M.|last4=Dunne|first4=V.|last5=Allan|first5=R.|last6=McCluskey|first6=P. J.|last7=Macdonald|first7=J.|last8=Thurtell|first8=M. J.|last9=Parker|first9=G. D.|date=2011-09-01|title=Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions|url=http://www.ajnr.org/content/32/8/1408|journal=American Journal of Neuroradiology|language=en|volume=32|issue=8|pages=1408–1414|doi=10.3174/ajnr.A2575|issn=0195-6108|pmid=21799038}}</ref>

==Causes==
Some causes of intracranial hypertension include:
* Venous stenosis
* [[craniocervical instability]]
* [[Chiari malformation]]
* and many more
When the cause of increased pressure is unknown it is called idiopathic intracranial hypertension (IIH). It was previously known as pseudotumor cerebri, as the symptoms can mimic that of a brain tumor, even though no tumor is present. It is considered to be a rare disease, affecting just 1 in 100,000 but milder forms may simply go unrecognized.

== Treatment ==
Treatment approaches may depend on the cause and whether it can be identified. In idiopathic cases, treatments can include reducing spinal fluid volume, e.g., through drug treatments like [[Diamox]] or surgical treatments like a shunt, or improving venous outflow (blood draining from the brain) by stenting veins in the brain or neck that may be narrowed.<ref name=":0" /><ref name=":1" /><ref name=":2" />

[[Ketamine]] is not a standard treatment for intracranial hypertension but was shown to reduce ICP by 30% in a controlled trial of 82 pediatric patients in a trauma setting.<ref>{{Cite journal|last=Bar-Joseph|first=Gad|last2=Guilburd|first2=Yoav|last3=Tamir|first3=Ada|last4=Guilburd|first4=Joseph N.|date=Jul 2009|title=Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension|url=https://www.ncbi.nlm.nih.gov/m/pubmed/19569909/|journal=Journal of Neurosurgery. Pediatrics|volume=4|issue=1|pages=40–46|doi=10.3171/2009.1.PEDS08319|issn=1933-0707|pmid=19569909}}</ref>

== Risk factors ==
* [[Ehlers-Danlos syndrome]]

==Related conditions==
{{Video|id=https://www.youtube.com/watch?v=FV92prEwfUY|service=youtube|dimensions=550|description=Dr. Kenneth Liu describes stenting in EDS patients with intracranial hypertension.|alignment=right|urlargs=}}It has been observed by some clinicians that ME/CFS and [[Ehlers-Danlos syndrome]] patients may have borderline or subclinical intracranial hypertension and benefit from IIH treatments such as [[Diamox]], venous stents, or shunts. While these treatments are rarely used by ME/CFS clinicians they are more commonly employed in the clinical care of EDS patients.

===ME/CFS ===
A case study of a woman presenting with symptoms of CFS and pressure headache, who was diagnosed with borderline intracranial hypertension, found that her CFS symptoms resolved with the placement of a transverse sinus stent.<ref>{{Cite journal|date=2002-04-01|title=Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance|url=https://www.sciencedirect.com/science/article/pii/S0022347602157878|journal=The Journal of Pediatrics|language=en|volume=140|issue=4|pages=412–417|doi=10.1067/mpd.2002.122725|issn=0022-3476}}</ref> A cross-sectional study of twenty patients presenting at a headache clinic found that a large proportion of patients had borderline intracranial hypertension, with four meeting the diagnostic criteria for IIH (mean cerebrospinal fluid pressure was 19 cm H<sub>2</sub>O (range 12–41 cm H<sub>2</sub>O); however, none had clinical signs of IIH. Cerebrospinal fluid drainage via lumbar puncture improved symptoms in 17/20 patients.<ref>{{Cite journal|last=Higgins|first=Nicholas|last2=Pickard|first2=John|last3=Lever|first3=Andrew|date=2013-11-21|title=Lumbar puncture, chronic fatigue syndrome and idiopathic intracranial hypertension: a cross-sectional study|url=http://journals.sagepub.com/doi/pdf/10.1177/2042533313507920|journal=JRSM Short Reports|language=en|volume=4|issue=12|pages=204253331350792|doi=10.1177/2042533313507920|issn=2042-5333|pmc=3899735|pmid=24475346}}</ref> Researchers speculate that a subset of CFS patients may have borderline cases of idiopathic intracranial hypertension without papillodema, that is, swelling of the optic nerve.<ref>{{Cite journal|last=Higgins|first=J. Nicholas P.|last2=Pickard|first2=John D.|last3=Lever|first3=Andrew M. L.|date=Aug 2017|title=Chronic fatigue syndrome and idiopathic intracranial hypertension: Different manifestations of the same disorder of intracranial pressure?|url=https://www.ncbi.nlm.nih.gov/pubmed/28735654|journal=Medical Hypotheses|volume=105|pages=6–9|doi=10.1016/j.mehy.2017.06.014|issn=1532-2777|pmid=28735654}}</ref>

The 2019 Bertelson/Bragée study<ref>{{Cite journal|last=Bragée|first=Björn|last2=Michos|first2=Anastasios|last3=Drum|first3=Brandon|last4=Fahlgren|first4=Mikael|last5=Szulkin|first5=Robert|last6=Bertilson|first6=Bo C.|date=2020-08-28|title=Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.frontiersin.org/article/10.3389/fneur.2020.00828/full|journal=Frontiers in Neurology|volume=11|pages=828|doi=10.3389/fneur.2020.00828|issn=1664-2295}}</ref> found evidence of IH in ME/CFS patients meeting the [[Canadian Consensus Criteria]].

Of 205 patients who underwent brain MRIs, 171 (83%) had an optic nerve sheath diameter/eyeball transverse diameter quotient (ONSD/ETD) >0.22, where the maximum found in healthy patients is 0.23<ref>{{Cite journal|last=Kim|first=Dong Hwan|last2=Jun|first2=Jin-Sun|last3=Kim|first3=Ryul|date=2017-12|title=Ultrasonographic measurement of the optic nerve sheath diameter and its association with eyeball transverse diameter in 585 healthy volunteers|url=http://www.nature.com/articles/s41598-017-16173-z|journal=Scientific Reports|language=en|volume=7|issue=1|pages=15906|doi=10.1038/s41598-017-16173-z|issn=2045-2322|pmc=PMC5698472|pmid=29162911}}</ref>. 87 patients (42%) had an ONSD/ETD > 0.25, which is the threshold for pathological<ref>{{Cite journal|last=Du|first=Jie|last2=Deng|first2=Yanjun|last3=Li|first3=Hua|last4=Qiao|first4=Shigang|last5=Yu|first5=Mengnan|last6=Xu|first6=Qingya|last7=Wang|first7=Chen|date=2020-04|title=Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasound Can Predict Intracranial Hypertension in Traumatic Brain Injury Patients: A Prospective Study|url=http://link.springer.com/10.1007/s12028-019-00762-z|journal=Neurocritical Care|language=en|volume=32|issue=2|pages=478–485|doi=10.1007/s12028-019-00762-z|issn=1541-6933}}</ref>.

Of 125 patients who underwent a cervical spine MRI, 100(80%) has some form of obstruction capable of increasing pressure- e.g. spondylolisthesis, osteophytes, cysts, syrinxes. 13.2% had tonsillar herniations severe enough to be considered a [[Chiari malformation|Chiari Malformation]].<ref name="Bertilson2019">{{Cite web|url=https://osf.io/qwn5h/|website=Center for Open Science|access-date=2019-12-03|title=Signs of Intracranial Hypertension, Hypermobility and Craniocervical Obstructions in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
|last=Bragée|first=Björn|authorlink=Björn Bragée|date=Nov 27, 2019|last2=Michos |first2=Anastasios|authorlink2=|last3=Fahlgren|first3=Mikael|last4=Drum|first4=Brandon|first5=Robert|last5=Szulkin|first6=Bo C|last6=Bertilson|archive-url=|archive-date=|dead-url=}}</ref>

===Ehlers-Danlos syndrome===
A number of EDS neurosurgeons have observed an association between intracranial hypertension and EDS.<ref>{{Cite journal|last=Henderson|first=Fraser C.|last2=Austin|first2=Claudiu|last3=Benzel|first3=Edward|last4=Bolognese|first4=Paolo|last5=Ellenbogen|first5=Richard|last6=Francomano|first6=Clair A.|last7=Ireton|first7=Candace|last8=Klinge|first8=Petra|last9=Koby|first9=Myles|date=2017|title=Neurological and spinal manifestations of the Ehlers–Danlos syndromes|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/ajmg.c.31549|journal=American Journal of Medical Genetics Part C: Seminars in Medical Genetics|language=en|volume=175|issue=1|pages=195–211|doi=10.1002/ajmg.c.31549|issn=1552-4876}}</ref> Penn State vascular neurosurgeon, Dr. [[Kenneth Liu]], has presented case studies of patients with EDS whose symptoms improve with venous stenting.<ref>{{Cite web|url=https://vimeo.com/190164038|title=Venous Stenting in Intracranial Hypertension|last=Liu|first=Kenneth|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

== Notable studies ==
* 2018, The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology<ref name=":3">{{Cite web|url=https://www.dovepress.com/the-link-between-idiopathic-intracranial-hypertension-fibromyalgia-and-peer-reviewed-article-JPR|title=The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology|last=Dankaerts|first=Wim|authorlink=|last2=Bruyninckx|first2=Frans|authorlink2=|date=2018-12-10|website=Journal of Pain Research|language=English|doi=10.2147/jpr.s186878|pmc=|pmid=30573989|archive-url=|archive-date=|dead-url=|access-date=2019-01-03|last3=Stalmans|first3=Ingeborg|last4=Vansant|first4=Greet|last5=Rasschaert|first5=Ricky|last6=Hulens|first6=Mieke}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292399/ (Full text)]

== See also ==
* [[Chiari malformation|Arnold-Chiari Malformation]]
* [[Cerebral Venous Stenosis]]
* [[Empty sella syndrome]]
* [[Fibromyalgia]]

== Learn more ==
* Video: [https://vimeo.com/190164038 Venous Stenting in Intracranial Hypertension], Dr. Kenneth Liu

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Potential comorbidities]]