Costa, D C, Tannock, C, Brostoff, J · QJM : monthly journal of the Association of Physicians · 1995
Researchers used a brain imaging technique to measure blood flow in the brains of ME/CFS patients and compared it to healthy people, as well as people with depression and epilepsy. They found that ME/CFS patients had consistently lower blood flow throughout their brains, especially in the brainstem—a critical area at the base of the brain that controls basic functions like breathing and heart rate. This pattern was distinct from what they saw in depressed patients, suggesting it may be a specific feature of ME/CFS.
This study provides objective neurobiological evidence that ME/CFS involves measurable brain abnormalities, potentially validating patients' experiences and distinguishing ME/CFS from psychiatric conditions. Brainstem hypoperfusion is particularly significant because this region controls autonomic functions often impaired in ME/CFS, offering a potential biological mechanism for symptom generation.
This study does not prove that brainstem hypoperfusion *causes* ME/CFS symptoms—it only documents an association. It cannot establish whether perfusion changes occur before symptom onset or develop as a consequence of illness. The cross-sectional design prevents determination of whether these abnormalities are stable, progressive, or reversible.
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
Costa, D C, Tannock, C, & Brostoff, J (1995). Brainstem perfusion is impaired in chronic fatigue syndrome.. QJM : monthly journal of the Association of Physicians. https://pubmed.ncbi.nlm.nih.gov/8542261/
BibTeX
@article{mecfsatlas-costa-1995-brainstem-perfusion,
author = {Costa, D C and Tannock, C and Brostoff, J},
title = {Brainstem perfusion is impaired in chronic fatigue syndrome.},
journal = {QJM : monthly journal of the Association of Physicians},
year = {1995},
note = {PubMed: 8542261},
url = {https://www.mecfsatlas.com/evidence/costa-1995-brainstem-perfusion},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/costa-1995-brainstem-perfusion
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