PEM warrants recognition as a neurological pathology resulting from metabolic and immune dysregulation (3). Approximately 48 hr after a triggering event—physical, cognitive, or emotional—patients experience what is colloquially termed a “crash.” This involves a surge in neurological symptoms that may render them unable to function: profound fatigue, cognitive slowing, hypersomnia, photophobia, phonophobia, tinnitus, nausea, headaches, migraines, executive dysfunction, word-finding difficulties, working memory impairment, pain, and worsening dysautonomia with orthostatic intolerance, mood disorders. Although these symptoms may be present at baseline, they rapidly escalate in the disabling cacophony of the “crash”. Many patients report diurnal variation, with symptoms peaking midday and easing somewhat towards night, repeating daily until resolution, suggesting a neuroimmune process with a circadian rhythm. Patients often experience disablement until the episode resolves over days or weeks.
Great to see a UK GP writing a BMJ e-letter like this:
"Research must consider Post Exertional Malaise as a neurological event underpinning fluctuating cognitive dysfunction in Long Covid"
www.bmj.com/content/390/...
#PEM #LongCovid