Abnormal Cerebral Perfusion in CFS

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Literature Review by S. Bell, MD, Lydonville News July 2005: Abnormal

Cerebral Perfusion in CFS

Reference: Schwartz R, Garada B, Komaroff A, Tice H, Gleit M, Jolesz F, et al.

Detection of intracranial abnormalities in patients with chronic fatigue

syndrome: comparison of MR imaging and SPECT. American Journal of

Roentgenology 1994;162:935-941.

This paper was one of the first to look at the incidence of both the " high

intensity " (bright) spots on the MRI scan and the brain blood flow

abnormalities in patients with CFS. The MRI abnormalities were present in

50% of patients compared with 20% of controls. The SPECT abnormalities

were common in CFS at 81% vs 21% in controls. The authors implied that the

SPECT seemed to correlate with the clinical picture.

There are now many papers on SPECT scans and cerebral perfusion studies.

For a review I would suggest: L, Corradi K, -Harding S, R,

King C. Chronic fatigue syndrome: the need for subtypes. Neuropsychology

Review 2005;15(1):29-58

Comment: For many years patients with CFS have said that their cognitive

symptoms are among the most disabling symptoms they experience. In the

early 1990's Dr. Sandman used the term " CFS dementia " and everyone was

horrified, including me. But it is now clear that he was correct, depending

upon how you define dementia.

Usually, we associate the term dementia with Alzheimer's disease, which

over a period of a few years converts a vital, intelligent person into one

unable to recognize family members. This does not occur in CFS. Over the

past twenty years I have heard patients say that their abilities are more and

more limited. I am sure this is true, but their speech was normal, they were

still

able to take care of themselves reasonably well. Because they had adjusted

to the ravages of the illness, some were even doing reasonably well. These

observations are not changed by the recent publications. What we are now

seeing in the medical literature is evidence that CFS is a neurological disease

and some patients have reduction in brain gray matter (cerebral atrophy).

I would feel that the results mentioned above are linked to the poor prognosis

seen in many of the CFS long term studies. For those persons with severe

CFS persisting for more than five years, the likelihood of recovery is slim. I

would assume that the neurological damage that causes the symptoms is

also causing the cerebral atrophy, and that is not likely to be reversed.

What is causing this cerebral atrophy? We do not know is the simple answer.

But for years we have seen abnormalities in the MRI scans, then SPECT

scans showing reduced blood flow to the brain. Sometimes I hear

neurologists say that the small " hyperintense " MRI lesions can be due to

vascular or embolic phenomena (tiny blood clots or strokes), and this

explanation is consistent with the reduced blood flow seen on studies. Like

CFS, multiple strokes will cause cerebral atrophy.

Could it be that the reduced blood flow to the brain is the cause of the

neurologic injury? Is there a hypercoagulable state causing these problems?

Is there " sludging " of the blood flow in the brain because of reduced

circulating blood volume? We don't know and it is time that serious research

is initiated on scale that occurred in multiple sclerosis years ago.

If the cerebral atrophy is due to reduced cerebral blood flow, it is

theoretically

preventable by opening the cerebral vessels and increasing the circulating

blood volume. I can be criticized for speculating here, but I freely say that I

do

not know. But we need the studies to find out.

ME/CFS is a debilitating disease of the central nervous system that causes

widespread disability. Unlike Alzheimer's disease, ME/CFS affects young

people in the prime of their life and affects children as well. It should no

longer

be considered a trivial problem. I am unhappy with these new research

developments, but I find them hard to refute. But it is even harder to witness a

medical world that continues to speculate whether CFS is " real " or not.