Signs and symptoms
When a patient is faced with possible chronic fatigue syndrome, we listen for the three characteristic symptoms that are the essence of this clinical syndrome. These symptoms are the top symptoms or very near the top of any litany of symptoms in CFS.
They are often striking, and 70 percent of the time follow an acute, infectious and usually viral syndrome or a major life event, injury or toxic exposure. They are as follows:
- Severe and dysfunctional fatigue with a post-exertional (physical or mental) collapse component.
- Neuropsychological complaints but especially memory, focus and processing speed problems, difficulty with multi-tasking and a sense of being easily overwhelmed with poor stress tolerance.
- Generalized pain but especially muscle and joint pain, headache and general body aches as well as migratory musculoskeletal pain.
There are physical signs seen (one or more) in virtually all CFS patients. A number of them, especially the vestibular dysfunction, appear to rapidly fluctuate with severity of illness.
It should be noted that almost all this data is recorded in a national referral practice for CFS in which nearly all patients have been ill for over five years (average: 15 years) and almost all are disabled with CFS. They include but are not limited to the following:
- Vestibular impairment in which instability, including falling over, is seen on tandem stance, romberg and augmented tandem stance (>90%)
- Increased deep tendon reflexes, especially in the lower extremities, which may include unsustained clonus at the ankles (>70% @ 3 plus or more)
- Tenderness in the supraclavicular node chain, posterior cervical node chain and axillary nodes but usually without lymphadenopathy (>60%)
- A so-called crimson crescent or red-to-purplish erythema, arching across the soft palate on either side of the uvula (>60%)
- Black radii or so-called corona radii, radiating around the pupil, but especially on and around the 12 o’clock position (>80%)
- Loss of height or degradation of the rete ridges which form the superficial finger print (>50%) and complete inability to obtain a good finger print in 10%.
- Mild clubbing of the finger nails (2+ or more in >80%)
- Low systolic blood pressure (<110 mmHg in >70%). Hypertension is rare and <2%. Low pulse pressure below 30 mmHg in >50%.
- Inability to adequately desaturate on pulse oximetry, despite a prolonged breath hold following end-expiration (0-3 points in >90% and 0-1 point in >50%)
- Diffuse abdominal tenderness, especially in the peri-umbilical region in the great majority (>80%)