Natelson, B H, Cohen, J M, Brassloff, I et al. · Journal of the neurological sciences · 1993 · DOI
Researchers compared brain scans (MRIs) of 52 people with ME/CFS to 52 similar healthy people. They found that ME/CFS patients were much more likely to have abnormal brain scans—27% compared to only 2% in the control group. The abnormalities included areas of white matter changes and some brain tissue enlargement, though the researchers noted that some of these findings might actually indicate other medical conditions rather than ME/CFS itself.
This study provides objective neuroimaging evidence that ME/CFS is not purely psychological and can be associated with demonstrable brain changes. However, it also highlights an important clinical message: abnormal brain imaging in ME/CFS patients warrants thorough evaluation for alternative medical diagnoses, improving diagnostic accuracy and appropriate treatment.
This study does not prove that brain MRI abnormalities are the direct cause of ME/CFS symptoms, nor does it establish how common these findings are in the broader ME/CFS population. The cross-sectional design cannot determine if the abnormalities precede, accompany, or result from illness. Additionally, it does not clarify whether MRI changes are specific to ME/CFS or represent a common feature of chronic illness.
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
Natelson, B H, Cohen, J M, Brassloff, I, & Lee, H J (1993). A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome.. Journal of the neurological sciences. https://doi.org/10.1016/0022-510x(93)90276-5
BibTeX
@article{mecfsatlas-natelson-1993-controlled-study,
author = {Natelson, B H and Cohen, J M and Brassloff, I and Lee, H J},
title = {A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome.},
journal = {Journal of the neurological sciences},
year = {1993},
doi = {10.1016/0022-510x(93)90276-5},
note = {PubMed: 8138812},
url = {https://www.mecfsatlas.com/evidence/natelson-1993-controlled-study},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/natelson-1993-controlled-study
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