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Myalgic Encephalomyelitis/chronic fatigue syndrome: a critical narrative review of modern concepts and unani perspectives.

BACKGROUND: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, disabling, multisystem illness characterized by persistent fatigue, post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE), unrefreshing sleep, and cognitive impairment. Classical Unani medicine does not recognize ME/CFS as a distinct disease entity. However, its descriptions of fatigue (I'yā), particularly I'yā Dhātī (spontaneous fatigue), provide a basis for examining parallels with ME/CFS. OBJECTIVE: To examine I'yā Dhātī (spontaneous fatigue) and its three simple subtypes (I'yā Qarūḥī, I…

Decompressive hemicraniectomy for fulminant acute disseminated encephalomyelitis following dengue fever: Case report and literature review.

BACKGROUND: Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated demyelinating disorder of the central nervous system that typically occurs after viral or bacterial infections. Although most patients respond favorably to immunomodulatory therapy, a small subset develops fulminant ADEM characterized by malignant cerebral edema, refractory intracranial hypertension, and a high risk of mortality. Decompressive craniectomy has rarely been reported as a life-saving intervention in such cases. CASE DESCRIPTION: A 25-year-old woman developed fulminant ADEM following dengue fever and…

Porcine hemagglutinating encephalomyelitis virus nucleocapsid protein targets RIG-I and IRF3 to evade IFN immunity.

The neurotropic betacoronavirus porcine hemagglutinating encephalomyelitis virus (PHEV) subverts early innate defenses to establish persistent neuronal infection. We show that PHEV activates RIG-I-MAVS signaling but hijacks this pathway to induce a delayed IRF7-dependent interferon (IFN-I) response (>12 h post-infection), permitting unchecked replication prior to late-phase immunity. Mechanistically, the viral nucleocapsid (N) protein directly engages RIG-I's caspase activation and recruitment domain (CARD) via its C-terminal domain (CTD), competitively blocking TRIM25-mediated K63-linked ubiq…

Postural Orthostatic Tachycardia Syndrome, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID as Neuroimmune Disorders.

Postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID are heterogeneous disorders with overlapping complex, multi-factorial and multi-systemic pathophysiology. POTS and ME/CFS are the most common phenotypes of Long COVID that can lead to significant disability and functional impairment. The exact pathophysiologic mechanisms of these disorders alone or in combination are still being investigated, but important mechanistic factors have been identified, such as autonomic dysfunction, immune dysregulation, autoimmunity, mitocho…

Handgrip strength in children, adolescents, and young adults with suspected myalgic encephalomyelitis/chronic fatigue syndrome.

BACKGROUND: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in children and young people (CYP) lacks validated diagnostic biomarkers. Post-exertional malaise (PEM) is central to case definitions and is usually assessed by patient report. We evaluated the feasibility and clinical value of handgrip strength (HGS) testing in PEM-reporting CYP referred for suspected ME/CFS. METHODS: In this prospective observational study at the Munich Chronic Fatigue Center for Young People (November 2022-November 2024), 147 patients (10-25 years) referred for the assessment of ME/CFS with positive D…

Fulminant acute hemorrhagic encephalomyelitis mimicking Guillain-Barré syndrome in a child: A fatal case report.

Acute hemorrhagic encephalomyelitis (AHE), or Weston Hurst disease, is vanishingly rare and almost always fatal. A fulminant variant of acute disseminated encephalomyelitis, it is defined by rapidly progressive demyelination, parenchymal necrosis, and hemorrhagic white matter destruction. Here we report a 4-year-old girl who arrived with ascending flaccid tetraparesis 1 week after a flu-like illness, a picture that, not unreasonably, pointed toward Guillain-Baré syndrome. Within 24 hours, the diagnosis collapsed: she developed impaired consciousness, bilateral Babinski signs, and dysphagia sig…

Comparative Gut Microbiome Alterations in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID-19 Syndrome.

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID-19 syndrome (LC) show substantial clinical overlap, but direct comparative microbiome studies remain limited. Methods: In this cross-sectional study, we compared the fecal gut microbiome of patients with ME/CFS, LC, and healthy controls (HC) within a unified analytical framework using 16S rRNA profiling, differential abundance testing, and multivariate modeling. We also examined associations between microbiome variation and questionnaire-derived symptom-domain scores. Results: Alpha-diversity did not differ …

High-intensity exercise training alters gut microbiota to mitigate the development of experimental autoimmune encephalomyelitis.

Exercise training (ET) has demonstrated beneficial effects in autoimmune and neurological disorders, including multiple sclerosis and its animal model, experimental autoimmune encephalomyelitis (EAE). ET modulates the gut microbiota, which influences neuroimmune interactions via the microbiota-gut-brain and microbiota-gut-immune system axes. However, the role of gut microbiota in mediating ET's protective effects in autoimmune neuroinflammation remains unclear. We investigated whether gut microbiota mediates the beneficial effects of ET on EAE development. Healthy mice underwent high-intensity…

Intravascular large B-cell lymphoma presenting as encephalomyelitis diagnosed by renal biopsy: a case report.

BACKGROUND: The assessment of patients with multifocal lesions in the brain and spinal cord is complicated. A comprehensive neurologic workup requires extensive imaging evaluation, lumbar puncture, and sometimes a stereotactic biopsy to identify the final diagnosis. We report a case of intravascular large B-cell lymphoma (IVLBCL) manifesting as encephalomyelitis, which was diagnosed via percutaneous renal biopsy. IVLBCL should be considered as a differential diagnosis in cases with brain and spinal cord involvement. CASE PRESENTATION: A 43-year-old man with no significant medical history pres…

Blood parameters differentiate post COVID-19 condition from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia.

Post-COVID-19 condition, such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia (FM), are characterized by fatigue, pain, shortness of breath, sleep disturbances, cognitive dysfunction and other symptoms, heavily impacting on patients daily functioning. Moreover, over half of patients end up fulfilling ME/CFS and/or FM clinical criteria after a few months of SARS-CoV-2 infection. Expression of the toxic human endogenous retrovirus (HERV)-W ENV protein can be induced by viral infection and HERV-W detection was correlated with acute COVID-19 severity and found signi…

Bridging the Gap: Opsoclonus-Myoclonus Syndrome: Human Pegivirus Encephalomyelitis Diagnosed Through Metagenomic Next-Generation Sequencing.

This case of encephalomyelitis in a previously healthy 21-year-old man who developed opsoclonus-myoclonus demonstrates the diagnostic utility of clinically validated metagenomic next-generation sequencing (mNGS), followed by appropriate confirmation, in complex cases of encephalitis. In this patient, an extensive diagnostic workup was negative for infectious, inflammatory, demyelinating, autoimmune, and paraneoplastic etiologies. However, clinically validated mNGS of the CSF identified human pegivirus (HPgV) as a potential causative agent. A 5-day course of IV immunoglobulins (IVIg) led to the…

Селективный ретиноид X рецептор агонизм способствует функциональному восстановлению и миелиническому ремонту в экспериментальном аутоиммунном энцефаломиелите.

Доказательства того, что ремонт миелина имеет решающее значение для функционального восстановления при множественном склерозе (МС), привели к идентификации бенсаротина (БХТ). Этот клинически многообещающий ремиелионирующий агент активирует множество подтипов ядерного гормонального рецептора, связанных с ремонтом миелина. Однако BXT вызывает неприемлемую гиперлипидемию. Напротив, IRX4204 избирательно активирует ретиноид X рецептор (RXR). Учитывая неопровержимые связи между активацией RXR и увеличением миелинового ремонта, мы использовали IRX4204 для исследования воздействия только агонизма RXR

Совпадение в аннотации оригинала
Evidence that myelin repair is crucial for functional recovery in multiple sclerosis (MS) led to the identification of bexarotene (BXT). Thi … the impact of RXR agonism alone on functional recovery in mice subjected to experimental autoimmune encephalomyelitis (EAE). Since gait deficits are common in MS, we used machine learning to obtain highly sensitive and reliable measurements of sagittal hindleg joint movements for mice walking on a treadmill. IRX4204 not only blocked the progressive loss of knee and …

A patient who recovered from post-COVID myalgic encephalomyelitis/chronic fatigue syndrome: a case report.

BACKGROUND: Some patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complain of persistent fatigue, dyspnea, pain, and cognitive dysfunction. These symptoms are often described as "long COVID". Whether a patient with long COVID might develop myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is of interest, as is the treatment and management of ME/CFS in a post-COVID patient. Here I report a patient, who, after an infection with SARS-CoV-2, developed ME/CFS and recovered after treatment. CASE PRESENTATION: The patient was a previously healthy 55-y…

WASF3 disrupts mitochondrial respiration and may mediate exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by various disabling symptoms including exercise intolerance and is diagnosed in the absence of a specific cause, making its clinical management challenging. A better understanding of the molecular mechanism underlying this apparent bioenergetic deficiency state may reveal insights for developing targeted treatment strategies. We report that overexpression of Wiskott-Aldrich Syndrome Protein Family Member 3 (WASF3), here identified in a 38-y-old woman suffering from long-standing fatigue and exercise intolerance, can …

Bilateral optic neuritis as the presenting sign of post SARS-CoV-2 acute disseminated encephalomyelitis.

PURPOSE: to report a case of Acute Disseminated EncephaloMyelitis (ADEM) occurring after documented SARS-Cov2 infection and flu-like disease. OBSERVATION: A 59-years-old woman presented with progressive visual loss and right leg paresthesia started 6 days earlier when CT scan excluded abnormalities. Visual acuity was OU hand motion with bilateral slow pupillary response and unremarkable ocular extrinsic motility while visual field testing showed diffuse bilateral sensitivity reduction. The patient had also right leg paresthesia and reported a 2-weeks flu-like syndrome 15 days earlier, with na…

Bickerstaff's brainstem encephalitis mimicking herpetic encephalomyelitis in a liver transplant patient with anti-GQ1b antibodies.

A woman in her late 70s with a history of liver transplant presented with ophthalmoplegia, ataxia, areflexia, positive Babinski's sign and reduced consciousness. This followed an antecedent illness in the form of a herpes zoster infection. MRI of the brain/spinal cord, cerebrospinal fluid analysis with viral PCR and routine blood tests were normal, and tacrolimus neurotoxicity was ruled out. Serum anti-GQ1b antibodies were positive. A diagnosis of Bickerstaff's brainstem encephalitis was made, forming part of the continuum that involves Miller-Fisher syndrome, entitled the 'anti-GQ1b syndrome'

Cerebral blood flow remains reduced after tilt testing in myalgic encephalomyelitis/chronic fatigue syndrome patients.

OBJECTIVE: Orthostatic symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may be caused by an abnormal reduction in cerebral blood flow. An abnormal cerebral blood flow reduction was shown in previous studies, without information on the recovery pace of cerebral blood flow. This study examined the prevalence and risk factors for delayed recovery of cerebral blood flow in ME/CFS patients. METHODS: 60 ME/CFS adults were studied: 30 patients had a normal heart rate and blood pressure response during the tilt test, 4 developed delayed orthostatic hypotension, and 26 developed…