An Integrated Neurovascular, Cranial Hydraulic and Sensory-Gating Model Graham Exelby Abstract Visual snow syndrome (VSS) is a neurological disorder characterised by the continuous perception of fine dynamic visual static across the visual field, commonly accompanied by palinopsia, photophobia, nyctalopia, enhanced entoptic phenomena, tinnitus and migraine.[1–4] Contemporary neuroimaging and electrophysiological studies support dysfunction extending beyond the primary visual

A Progressive Clinical and Scientific Exploration of Recovery Dr Graham Exelby This work did not begin with a new theory. It began with patients. Over approximately 15 years, and through the assessment of more than 700 patients with POTS, Long COVID and related disorders, I repeatedly encountered patients whose illness could not be satisfactorily explained by existing diagnostic models. Many were profoundly disabled despite apparently reassuring routine investigations. Others

Dr Graham Exelby May 2026 Abstract Background Postural Orthostatic Tachycardia Syndrome (POTS) and Long COVID frequently demonstrate abnormalities of the renin–angiotensin–aldosterone system (RAAS), yet the physiological significance of these findings remains poorly understood. Conventional endocrine testing protocols were developed primarily to identify primary aldosteronism and do not adequately assess dynamic neurovascular control responses during orthostatic stress. Incre

Christopher Thomas, BScApp. MScSt. AMS. DMU, Dr Graham Exelby , MBBS February 2026 Abstract Background: Postural orthostatic tachycardia syndrome (POTS), Long COVID–associated dysautonomia, and post-vaccine syndromes are typically defined by heart-rate responses and autonomic testing, with limited direct assessment of preload or forward flow. Emerging population-level data identify an orthostatic cardiac output–fall phenotype characterised by stroke-volume reduction despite p

An Integrated Hydraulic–Neurovascular Framework Linking the Brain, Neck and Body Cranial Venous Drainage, Cavernous Sinus Physiology, Neurovascular Adaptation and the Distinct Mechanisms of Upright and Supine Head Pressure Dr Graham Exelby July 2026 Executive Statement Many patients present with overlapping symptoms—including head pressure, migraine, dizziness, pulsatile tinnitus, retro-orbital pain, visual disturbance, coathanger pain, brain fog and orthostatic intolerance

Dr Graham Exelby 2026 Abstract Successful recovery following infection, injury and physiological stress requires coordinated resolution of inflammatory signalling, restoration of microvascular function, tissue repair and rebuilding of physiological reserve. Although persistent inflammation, endothelial dysfunction, mitochondrial abnormalities and chronic hypoxic signalling have each been implicated in Long COVID, postural orthostatic tachycardia syndrome (POTS), myalgic...

Dr Graham Exelby 2026 Abstract Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic multisystem disorder characterised by post-exertional malaise (PEM), autonomic dysfunction, cognitive impairment, sleep disturbance and profound loss of functional capacity. Although abnormalities involving cerebral perfusion, endothelial function, neurovascular coupling, mitochondrial metabolism, immune activation and autonomic regulation have each been describ

Dr Graham Exelby 2026 About This Paper This document is a simplified companion to a series of more detailed scientific papers exploring Long COVID, POTS, ME/CFS and related disorders. The formal papers examine the underlying biology in depth, including neurovascular dysfunction, pericyte biology, autonomic regulation, inflammatory signalling, metabolism, recovery physiology and the renin–angiotensin–aldosterone system (RAAS). While these concepts are important, the scientific

Dr Graham Exelby June 2026 About This Paper This paper is part of the Understanding Series, a collection of companion guides designed to explain complex medical concepts in a practical and accessible way for patients, families and healthcare professionals. The aim of this paper is to explain how recovery may become impaired in Long COVID, POTS, ME/CFS and related disorders using straightforward language. Many important scientific concepts have therefore been simplified to imp

Dr Graham Exelby 2026 Abstract Hashimoto's thyroiditis and thyroid nodules are traditionally viewed as manifestations of autoimmune and endocrine disease arising from genetic susceptibility, environmental triggers, loss of immune tolerance, thyroid autoantibody production, and progressive glandular dysfunction. While these mechanisms remain central to disease pathogenesis, they incompletely incorporate the regional venous and lymphatic anatomy upon which normal thyroid physio

Authors: Dr Graham Exelby1,2 & Dr Cris Beer1,3. 2025. 1MCMC-Research Collaborative, Gold Coast, Australia 2 University of Queensland School of Medicine (Adjunct), Brisbane 3Integrative Gynaecology & Women’s Health, Gold Coast Reviewed by Dr Valerio Vittone (PhD), Gold Coast Abstract Endometriosis is traditionally defined as ectopic endometrial-like tissue that evades immune clearance. Emerging molecular, vascular, and immunometabolic data suggest this view is incomplete. Evi

Dr Graham Exelby (2026) Systems-Level Insights Derived from Genomic Studies in POTS and Long COVID (2022–2026) with Dr Valerio Vittone Abstract Background POTS, Long COVID, ME/CFS, vaccine-associated syndromes, and connective tissue-associated neuroimmune disorders are traditionally approached as distinct clinical entities. However, increasing overlap in autonomic dysfunction, neurovascular abnormalities, inflammatory activation, connective tissue signatures, oxidative stress

Dr Graham Exelby 2026. Abstract The post-2020 rise in ADHD diagnoses, particularly among adolescents and young adults, coincides temporally with the COVID-19 pandemic and raises important questions regarding causality versus increased diagnostic awareness. This paper proposes an integrated physiological model in which SARS-CoV-2 infection acts as a systems-level stressor, unmasking or amplifying ADHD- and ASD-like phenotypes through disruption of preload-dependent cerebral pe

A personal update from Dr Graham Exelby June 2026 Over the past several years, what started as an attempt to better understand POTS has evolved into a much broader investigation of Long COVID, ME/CFS, Fibromyalgia, migraine, Ehlers-Danlos syndrome, chronic head pressure syndromes and related disorders. The more patients we studied, the clearer it became that many of these conditions may not be separate diseases at all. Instead, they appear to share common physiological pathwa

Dr Graham Exelby December 2025- in peer review Preview: This diagram shows the root network of all chronic immunometabolic diseases: hypoxia HIF-1α → HIF-2α reprogramming ROS / RAGE / NF-κB activation STAT3–CCL2 macrophage/microglial loops NLRP3 inflammasome pericyte dropout BBB leak mast-cell activation mitochondrial failure / PDH shutdown glycolytic trap autonomic failure central sensitisation This is the “motherboard,” where from this “motherboard,” you can derive variants

Dr Graham Exelby, September 2025 Extracted from “EBV Reactivation in Long COVID: A Mechanistic Synthesis,” September 2025...

Dr Graham Exelby September 2025. This is a personal opinion and may differ from that of your medical advisers. Introduction Many centres...

Dr Graham Exelby September 2025 Background : I have been involved in a long term longitudinal study of this problem, initially comparing...

A Unifying Molecular Pathway Across Malignancy, Autoimmunity, and Immune Dysregulation Dr Graham Exelby June 2025- revised September 2025...

Dr Graham Exelby May 2025 Introduction Chronic hypoxia is a powerful initiator of immune dysregulation, neurovascular injury, and...