Abstract There is accumulating evidence of orly happy camper endothelial dysfunction, muscle and cerebral hypoperfusion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).In this paper we deduce the pathomechanisms resulting in central nervous pathology and the myriad of neurocognitive symptoms.We outline tentative mechanisms of impaired cerebral blood flow, increase in intracranial pressure and central adrenergic hyperactivity and how hand wipes individual packets they can well explain the key symptoms of cognitive impairment, brain fog, headache, hypersensitivity, sleep disturbances and dysautonomia.