Biswal, Bharat, Kunwar, Pratap, Natelson, Benjamin H · Journal of the neurological sciences · 2011 · DOI
Researchers used a brain imaging technique called arterial spin labeling to measure blood flow in the brains of 11 ME/CFS patients and 10 healthy people. They found that ME/CFS patients as a group had significantly lower blood flow to their brains compared to healthy controls, though this pattern wasn't universal—some patients showed normal or even slightly increased blood flow. This suggests that reduced brain blood flow may be one physical feature of ME/CFS, though it doesn't affect all patients in the same way.
This study provides objective neuroimaging evidence that ME/CFS has a measurable biological substrate in the brain—specifically altered cerebral blood flow—which supports the legitimacy of ME/CFS as a neurological condition. The confirmation of findings using two different imaging methods strengthens confidence in this observation, and the identification of heterogeneous responses may help explain why ME/CFS symptoms and severity vary among patients.
This study does not prove that reduced cerebral blood flow causes ME/CFS symptoms—it only shows an association. The study does not establish whether CBF changes are a primary cause, a secondary consequence of the disease, or related to another underlying mechanism. The small sample size and lack of clinical correlation data limit ability to determine which patients' symptoms are most related to their CBF changes.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Biswal, Bharat, Kunwar, Pratap, & Natelson, Benjamin H (2011). Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling.. Journal of the neurological sciences. https://doi.org/10.1016/j.jns.2010.11.018
BibTeX
@article{mecfsatlas-biswal-2011-cerebral-blood,
author = {Biswal, Bharat and Kunwar, Pratap and Natelson, Benjamin H},
title = {Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling.},
journal = {Journal of the neurological sciences},
year = {2011},
doi = {10.1016/j.jns.2010.11.018},
note = {PubMed: 21167506},
url = {https://www.mecfsatlas.com/evidence/biswal-2011-cerebral-blood},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/biswal-2011-cerebral-blood
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