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Q J Med 1995; 88: 767-773
© 1995 Association of Physicians

Brainstem perfusion is impaired in chronic fatigue syndrome

D.C. COSTA, C. TANNOCK1 and J. BROSTOFF2

Institute of Nuclear Medicine London,UK 1 Department of Psychiatry London, UK 2 Department of Immunology, UCL Medical School London, UK

Address correspondence to Dr D.C. Costa, Institute of Nuclear Medicine, UCL Medical School, UCL Hospitals, Mortimer Street, London WIN 8AA

Received 12 April 1995 Accepted for publication 29 June 1995.


  Abstract

We looked for brain perfusion abnormalities in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). An initial pilot study revealed widespread reduction of regional brain perfusion in 24 ME/CFS patients, compared with 24 normal volunteers. Hypoperfusion ofthe brainstem (0.72±0.05 vs. 0.80±0.04, p<0.0001) was marked and constant. We then tested whether perfusion to the brainstem in ME/CFS patients differs from thatin normals, patients with major depression, and others with epilepsy. Data from a total of 146 subjects were included in the present study: 40 normal volunteers, 67 patients with ME/CFS(24 in the pilot study, 16 with no psychiatric disorders, 13 with ME/CFS and depression, 14 with ME/CFS and other psychiatric disorders), 10 epileptics, 20 young depressed patientsand 9 elderly depressed individuals. Brain perfusion ratios were calculated using 99Tcm-hexamethylpropylene amine oxime (99Tcm- HMPAO) and single-photon emission tomography (SPET) with a dedicated three-detector gamma camera computer/system (GE Neurocam). Brainstem hypoperfusion was confirmed in all ME/CFS patients. Furthermore, the 16 ME/CFS patients with no psychiatric disorders and the initial 24 patients inthe pilot study showed significantly lower brainstem perfusion (0.71$0.03) than did depressed patients (0.77$0.03; ANOVA, p<0.0001). Patients with ME/CFS have a generalized reduction of brain perfusion, with a particular pattern of hypoperfusion of the brainstem.


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