CNS findings in chronic fatigue syndrome and a neuropathological case report

[PDXhausted]

Can anyone who can see the full text say the age and comorbidities of the patient? I don't see this sci hub link that @Kati mentions?

 

[halcyon]

Can anyone who can see the full text say the age and comorbidities of the patient? I don't see this sci hub link that @Kati mentions?

Here, we present neuropathological findings from a case of CFS from a 72-year old Caucasian woman who died from aspiration pneumonia due to hypertensive cerebrovascular disease. According to the patient’s daughter, prior to 1974, the patient led an active life managing all household duties including finances. She worked as a volunteer in the local hospital’s emergency department and managed a concession stand at local sporting events. Beginning in 1974–1975, the patient began to repeat herself and have cognitive problems such as confusion. In 1975, she participated in a golf tournament but could not remember the event or how she got home. The patient then continued to decline and suffered from malaise, headache, joint and muscle pain, swollen lymph nodes and ‘brain fog’ that persisted for over 6 months. Rest did not alleviate these problems. Other significant medical history included a diagnosis of CFS made in 1987, fibromyalgia, celiac disease and hypothyroidism. The diagnosis of CFS was made according to the Holmes criteria,73 whereby the patient met both major clinical criteria 1 and 2, and 6 or more of the 11 symptom criteria and 2 or more of the 3 physical criteria, or 8 or more of the 11 symptom criteria.73 Criterion 1 is defined as “new onset of persistent or relapsing, debilitating fatigue in a person who has no previous history of similar symptoms that does not resolve with bed rest, and that is severe enough to reduce or impair average daily activity below 50% of the patient’s premorbid activity level for a period of at least 6 months.”73 Criterion 2 is the exclusion of other clinical conditions that may produce similar symptoms. For a detailed list of these conditions, see reference73. In 1987, she was admitted to hospice 10 days prior to death with a diagnosis of general decline. Within the previous week, she had acute psychotic episodes that included persecutory and somatic delusions and delusions of reference where the patient said, “There is something wrong in my brain. I am dying. People are trying to kill me.” She also experienced auditory hallucinations where the patient reported that voices said they were going to kill her. Three days prior to death, she was in a coma after suffering a presumed stroke.

Full paper is here.

 

[PDXhausted]

@halcyon thank you!

 

[Kati]

What is so striking to me is that it took 30 long years to publish a paper from the time of death till now. That is incredibly long. Earlier publishing would have meant hopefully other teams being curious and wanting to autopsy another person with these findings in mind.

Maybe this person's samples were in a freezer bottom shelf somewhere for all that time and found by the current investigators.

So very sad.

 

[charles shepherd]

Is there any general biobank for post mortem samples one can sign up for?
Accidents happen, and whatever the case, at some point, we're not going to need them.

Here in the UK we carried out a feasibility study to establish a formal post-mortem tissue bank for ME/CFS - the same as trhe 'brain banks' that currently exist for other neurological diseases

The feasibilty report was published in the Journal of Clinical Pathology:
http://jcp.bmj.com/content/63/11/1032.short

Abstract

Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a condition, the aetiology of which remains controversial, and there is still no consensus on its nature and determination. It has rarely been studied in post-mortem examinations, despite increasing evidence of abnormalities from neuroimaging studies.

Aim To ascertain the feasibility of developing a national post-mortem ME/CFS tissue bank in the UK, to enhance studies on aetiology and pathogenesis, including cell and tissue abnormalities associated with the condition.

Methods The case study was carried out combining qualitative methods, ie, key informant interviews, focus group discussions with people with ME/CFS, and a workshop with experts in ME/CFS or in tissue banking.

Results and conclusions The study results suggest that the establishment of the post-mortem ME/CFS tissue bank is both desirable and feasible, and would be acceptable to the possible tissue donors, provided that some issues were explicitly addressed.

Unfortunately, this initiative has not progressed and currently sits in pending - mainly due to the high cost involved and that the fact that as a charity we cannot afford to pay for the running costs of both a (blood sample) Biobank and a post-mortem 'Brain Bank'

CS

 

[Maya24]

Here is another article on Dorsal Root Ganglion if you want to know more.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287412/
"The DRG is located between the dorsal root and the spinal nerve. It contains pseudounipolar neurons that convey sensory information from the periphery to the CNS. Following nerve injury or inflammation, these neurons may become an important source of increased nociceptive signaling through increased neuronal excitability and generation of ectopic discharges.5,6This provides an excellent opportunity for the anesthesia of DRG neurons in order to prevent the development of these pathological discharges.

The DRG also lacks a protective surrounding capsular membrane, unlike the perineurium that protects the peripheral nerve fascicles and regulates their internal milieu.7 It has a permeable connective tissue capsule, which makes it an excellent choice for drug application.7 This permeability can be partly explained by a very high density of blood capillaries in the ganglion tissue.8 This rich blood supply may also explain why the DRG is tolerant to the intraneuronal local anesthetic injection, since toxic concentration cannot be easily reached due to high perfusion rates.9"


********

"A limitation for DRG delivery is the location of the ganglion, which makes it difficult to reach. DRGs are protected by the bony structures of the vertebra. To reach DRGs in animal models, one needs to drill a hole
In the bone covering the ganglion. In humans, due to larger structures, it is possible to access most of the DRGs via intervertebral foramen by carefully positioning a patient and navigating a needle using radiographic or ultrasound imaging, as shown by several approaches already used in a clinical setting. Pulsed radiofrequency (RF) of DRGs is a therapeutic procedure during which a heat lesion is placed sufficiently near the DRG to produce what is called a partial lesion, but not so close as to completely destroy the ganglion.39Selective nerve root blocks (SNRBs) have been used for many years as a diagnostic tool in patients with lower back pain with radicular symptoms, as well as for pain relief. This technique also involves structures beyond the intervertebral foramen. However, patient responses to SNRBs are often non specific and pain relief after injecting local anesthetic is often difficult to interpret.40

The DRG can be injured during SNRBs.9 However, these injections into the DRG are well tolerated. The cervical level is a very important exception since there is a very short length from the DRG to the spinal cord, where arrival of the injected drug may produce disastrous cord damage.11"