Dickinson, C J · European journal of clinical investigation · 1997 · DOI
This review examines why ME/CFS develops, looking at evidence from 40 years of research. The author discusses how ME/CFS may involve damage to the brain stem (the oldest part of the brain that controls basic functions like sleep and alertness), possibly from a previous viral infection. Brain imaging studies have found small patches of damage in the brain stems of some ME/CFS patients, similar to what is seen in other conditions like post-polio fatigue.
This study is important because it offers a neurobiological framework for understanding ME/CFS—proposing brainstem damage rather than purely psychological causes. By drawing parallels to post-polio fatigue syndrome (where similar lesions are well-documented), the author provides a mechanistic rationale for why ME/CFS patients have persistent fatigue and cognitive dysfunction, potentially opening therapeutic avenues.
This review does not prove that all ME/CFS cases result from RAS damage, nor does it establish causation between viral infection and brainstem lesions. The inconsistencies in imaging studies noted by the author mean the brainstem hypothesis remains unproven. Additionally, the review does not differentiate between primary viral injury and secondary inflammatory or immune-mediated damage.
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
Dickinson, C J (1997). Chronic fatigue syndrome--aetiological aspects.. European journal of clinical investigation. https://doi.org/10.1046/j.1365-2362.1997.1120664.x
BibTeX
@article{mecfsatlas-dickinson-1997-chronic-fatigue,
author = {Dickinson, C J},
title = {Chronic fatigue syndrome--aetiological aspects.},
journal = {European journal of clinical investigation},
year = {1997},
doi = {10.1046/j.1365-2362.1997.1120664.x},
note = {PubMed: 9134372},
url = {https://www.mecfsatlas.com/evidence/dickinson-1997-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/dickinson-1997-chronic-fatigue
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