Ramsay Criteria for M.E. (1988)


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Ramsay Description of M.E.

M.E. is an endemic disease which is subject to periodic epidemics.



Onset may be sudden and without apparent cause, for example a sudden attack of acute vertigo. There is usually a history of acute infection of the upper respiratory tract or, occasionally, the gastrointestinal tract. All cases have low-grade pyrexia (up to 38 degrees C) usually subsiding within a week.

Subsequently there is persistent and profound fatigue, accompanied by a medley of symptoms such as headache, giddiness and a number of muscle symptoms such as pain, cramp, twitching, tenderness and weakness (especially after exercise).

Other symptoms include paraesthesia, frequency of micturition [urination], blurred vision and/or diplopia, hyperacusis (sometimes alternating with deafness or normal hearing), tinnitus, fainting attacks which may be the result of hypoglycaemia, and a general sense of “feeling awful.”


The Established Syndrome:

Once the syndrome is fully established there are three groups of symptoms.


1. Muscle phenomena

* Muscle fatiguability. Even after a minor degree of physical exercise, three or more days may elapse before full muscle power is restored. This feature is unique and is the “sheet anchor” of diagnosis. In moderate cases there may be normal muscle power in remission.

* Muscle spasm and twitching. In severe cases there may be swollen and very tender bands of muscle including minute focii of exquisite tenderness in trapezii and gastrocnemii (the muscle groups most commonly involved).


2. Circulatory impairment

* Cold extremities

* Hypersensitivity to climactic change

* Ashen gray facial pallor, 20 to 30 minutes before patient complains of being ill


3. Cerebral Dysfunction


Cardinal Features:

* Impairment of memory

* Impairment of powers of concentration

* Emotional lability


Other common features:

* Using the wrong words

* Alteration to sleep rhythm or vivid dreams

* Frequency of micturition

* Hyperacuisis

* Episodic sweating

* Orthostatic tachycardia


Other Notable Features

* Variability of both symptoms and clinical findings during the day

* Tendency to become chronic. Estimate at least 25%


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