Nelson, Todd, Zhang, Lan-Xin, Guo, Hui et al. · Frontiers in neurology · 2021 · DOI
This review examined brain imaging studies to understand how ME/CFS affects the brainstem, which is the part of the brain that controls vital functions like heart rate, breathing, and sleep. Researchers found that people with ME/CFS often show changes in the brain's structure and how different brain regions communicate with each other. These findings suggest that problems in the brainstem might explain many ME/CFS symptoms, though more research is needed to fully understand the connections.
This review consolidates emerging evidence that brainstem dysfunction may be a key biological feature of ME/CFS, helping legitimize the search for measurable brain abnormalities in this condition. Understanding brainstem involvement could guide future diagnostic approaches and targeted therapeutic interventions, improving clinical management and validating the biomedical nature of ME/CFS.
This review does not prove that brainstem abnormalities cause ME/CFS symptoms—it documents associations found on imaging studies. The findings are correlational and do not establish definitive causation or identify which abnormalities are primary versus secondary. Individual study limitations and the heterogeneous nature of findings mean this review cannot yet provide a unified explanation for all ME/CFS pathophysiology.
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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Primary citation
Nelson, Todd, Zhang, Lan-Xin, Guo, Hui, Nacul, Luis, & Song, Xiaowei (2021). Brainstem Abnormalities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Scoping Review and Evaluation of Magnetic Resonance Imaging Findings.. Frontiers in neurology. https://doi.org/10.3389/fneur.2021.769511
BibTeX
@article{mecfsatlas-nelson-2021-brainstem-abnormalities,
author = {Nelson, Todd and Zhang, Lan-Xin and Guo, Hui and Nacul, Luis and Song, Xiaowei},
title = {Brainstem Abnormalities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Scoping Review and Evaluation of Magnetic Resonance Imaging Findings.},
journal = {Frontiers in neurology},
year = {2021},
doi = {10.3389/fneur.2021.769511},
note = {PubMed: 34975729},
url = {https://www.mecfsatlas.com/evidence/nelson-2021-brainstem-abnormalities},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/nelson-2021-brainstem-abnormalities
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