Edwards, Charles C, Edwards, Charles C, Heinlein, Scott et al. · Frontiers in neurology · 2023 · DOI
This case report describes a woman who was thought to have ME/CFS and experienced symptoms of dizziness upon standing (orthostatic intolerance). Doctors discovered she actually had cervical spinal stenosis—a narrowing of the spinal canal in her neck that was compressing her spinal cord. After surgery to relieve the compression, her ME/CFS and orthostatic intolerance symptoms improved significantly. Years later, her symptoms returned because the surgical implant shifted, compressing the spinal cord again. A second surgery provided similar improvement, suggesting that spinal stenosis may have been causing or worsening her ME/CFS symptoms rather than the other way around.
For ME/CFS patients with orthostatic intolerance and neurological symptoms that are difficult to treat, this study highlights the importance of considering structural spinal pathology in the differential diagnosis. The finding that symptom recurrence paralleled imaging findings of re-compression provides stronger mechanistic evidence than the initial series, suggesting surgical intervention may benefit a carefully selected subset of ME/CFS patients with underlying cervical stenosis.
This case report does not prove that cervical spinal stenosis causes ME/CFS in the general ME/CFS population, nor does it establish how common this overlap is. It cannot demonstrate causation definitively, only association in this individual patient. The findings cannot be generalized beyond patients with specific neurological signs and imaging-confirmed stenosis, and do not address whether most ME/CFS patients would benefit from similar screening or intervention.
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 →
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