C. M. C. van Campen, F. C. Visser, P. C. Rowe · Journal of Internal Medicine · 2020 · DOI
In the largest study of its kind, 429 ME/CFS patients underwent head-up tilt testing with simultaneous cerebral blood flow monitoring. Nearly all ME/CFS patients showed significantly reduced cerebral blood flow when upright, even when blood pressure and heart rate were normal. The reduction correlated with symptom severity.
This large study demonstrates that reduced brain blood flow in upright posture is nearly universal in ME/CFS — even without classic POTS criteria being met. It explains the cognitive symptoms and post-exertional worsening that many patients experience and suggests that hemodynamic support may be a treatment avenue.
This study cannot determine whether reduced cerebral blood flow is a cause of ME/CFS, a consequence, or simply a feature. Treatment implications require separate trial evidence.
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
C. M. C. van Campen, F. C. Visser, & P. C. Rowe (2020). Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia. Journal of Internal Medicine. https://doi.org/10.1111/joim.13042
BibTeX
@article{mecfsatlas-van-campen-2020-cerebral-blood-flow,
author = {C. M. C. van Campen and F. C. Visser and P. C. Rowe},
title = {Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia},
journal = {Journal of Internal Medicine},
year = {2020},
doi = {10.1111/joim.13042},
url = {https://www.mecfsatlas.com/evidence/van-campen-2020-cerebral-blood-flow},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/van-campen-2020-cerebral-blood-flow
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