Journal of IiME Volume 6 Issue 1 (June 2012) diastolic blood pressure were recorded 10 min prior to the procedure, immediately before, at the end of the procedure, and 10 min after the end of the procedure. Thickness of the biceps brachii was measured with the same probe, but this time with the conventional setting for muscle-skeletal examination. Results During 10 min transcranial sonography, no side effect was reported. The parameters adopted for visualization of the temporal cortex allowed to distinguish the meninges, the subarachnoidal space and the cortex (Fig. 2). The meninges appeared as a well organized array of layers of about 5 mm thickness. The thickness of the cortex (3.8 mm) led us to hypothesize that we were observing the temporal areas designated as TG and TE, i.e. those areas involved in the control of eye movements and balance in standing position (area TE), social behaviour, mood and decision making (area TG). It is worth remembering that most of these functions are altered to various degrees in ME/CFS patients’ symptoms (2). The spatial resolution and the ability to visualize structures of 200-300 µm size, led us to hypothesize that the linear structures (alternate gray-white stripes) parallel to the sub-arachnoidal space could be referred to the well known neuronal layers of the cortex (15). Considering the role of neuronal layer architecture alterations in neurodegenerative diseases (16), detailed study of these layers in ME/CFS might prove instrumental in diagnosis, prognosis and follow-up. With this type of setting and using Doppler technique, we could also observe arterial vascularisation of the meninges and pulsating arteries of less that one mm diameter could be easily visualized (Fig. 3). During transcranial sonography, we could also observe a peculiar pulsation of the meninges and of the cortex that was synchronous with the heart beat, but was not accompanied by any type of flow. This pulsation was more evident at the level of the meninges, but was also appreciable at the level of the layers of the cortex. A similar type of pulsation was described in 1987 by Klose et al. who used Magnetic Resonance Imaging to study the oscillation of the cerebrospinal fluid within the cardiac cycle (17). We have no evidence, as yet, that the observed pattern of brain pulsation may be altered in ME/CFS patients nor that this observation may contribute to diagnosis or followup. However, the easy reproducibility of the Invest in ME (Charity Nr. 1114035) procedure as well as the absence of any discomfort, render this type of approach worth of further investigation. In fact, it was proposed that alteration of the so-called cranial rhythmic impulse might have a role in the pathogenesis of ME/CFS (18), and spinal fluid abnormalities are common in ME/CFS patients (19). Although the primary goal of our research was to set up a technique to study brain morphology and function in ME/CFS patients, while performing transcranial sonography with the indicated setting, we noticed that some notable changes happened in the subject who was at the same time the operator of the echo machine and the object of observation. In fact, an ill-defined feeling of strength and well-being that had been reported during the first measures prompted us to further investigate whether the ultrasounds used for imaging could somehow affect brain function. The use of transcranial ultrasounds in both military and civilian settings to stimulate the central nervous system has been recently proposed (http://www.darpa.mil/Opportunities/Universities /Young_Faculty_Award_Recipients.aspx) (20), and a preliminary study performed at the University of Arizona demonstrated that transcranial ultrasound stimulation improved mood and increased heart rate, systolic and diastolic pressure and decreased oxygen saturation (http://www.quantumconsciousness.org/docume nts/ATUS201101634A.pdf ). In the study reported above, however, transcranial ultrasound application was performed by an operator and the subject being investigated did not look at his own brain while performing the procedure. This difference might be significant because of the ensuing bio-feedback, an effect that has proven effective in a variety of conditions from neurological disorders to cancer (21, 22). In our study, we observed that heart rate significantly decreased from 81 beats per minute (bpm) at the beginning of the procedure to 71 bpm at the end of the procedure, to 70 bpm 10 min after the end of the procedure. Systolic blood pressure increased from 115 mm/Hg (10 min before the procedure) to 125 mm/Hg (10 min after the end of the procedure). Unlike the study quoted above, diastolic pressure did not change and remained constant at 75 mm/Hg before and after the procedure. It is well assessed that cardiovascular symptoms and hypotension are www.investinme.org Page 25 of 108
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