BMJ: CNS findings in CFS Autopsy and a neuropathological case report


Does anyone have access to the full paper, please? It costs nearly £30 to download it.

Original research

CNS findings in chronic fatigue syndrome and a neuropathological case report

  1. Kimberly Ferrero1,
  2. Mitchell Silver1,
  3. Alan Cocchetto2,
  4. Eliezer Masliah3,
  5. Dianne Langford1
Author affiliations

Chronic fatigue syndrome (CFS) is characterized as a persistent, debilitating complex disorder of unknown etiology, whereby patients suffer from extreme fatigue, which often presents with symptoms that include chronic pain, depression, weakness, mood disturbances, and neuropsychological impairment. In this mini review and case report, we address central nervous system (CNS) involvement of CFS and present neuropathological autopsy findings from a patient who died with a prior diagnosis of CFS. Among the most remarkable pathological features of the case are focal areas of white matter loss, neurite beading, and neuritic pathology of axons in the white matter with axonal spheroids. Atypical neurons displaying aberrant sprouting processes in response to injury are observed throughout cortical gray and white matter. Abundant amyloid deposits identical to AD plaques with accompanying intracellular granular structures are observed as well. Neurofibrillary tangles are also present in the white matter of the frontal cortex, thalamus and basal ganglia. Taken together, these neuropathological findings warrant further studies into CNS disease associated with CFS.
I tried Sci-hub and it didn't work for me.
However, one of our members has sent it to me in a PM and I see @Judee has posted it above.

I am puzzled by this paper. I have only skimmed it as yet, but the patient also seems to have had vascular dementia, so why are they assuming that the abnormal findings are due to ME?
Is this it? I put the title in duckduckgo and then open sites til I found one that had what I think is the full paper.

medical record:

"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."

histology finding discussion:

"First of all, AD-like pathology and vascular
changes were observed. However, unlike AD, this case does
not show typical dystrophic neurites. On the other hand,
the tauopathy observed may not necessarily explain the
mechanisms of cellular dysfunction but rather serves as a
useful (pathological or phenotypic) marker for CFS. Taken
together, holistic analysis of the neuropathological findings
from this case point to severe neuronal dysfunction with
hallmarks characteristic of neurodegeneration. This being
the first neuropathological report of a CFS case points to
the need for more extensive large-scale investigations into
the neuropathologies associated with CFS in order to establish
a consistent rubric for identification, diagnosis and
scoring of the syndrome as part of a greater class of CNS
diseases with similar clinical presentation."