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This cellular energy crisis directly manifests as the profound physical fatigue, "brain fog," and post-exertional malaise (PEM) that patients experience

At the biochemical level, iron-mediated oxidative stress is largely driven by the Fenton reaction, which converts hydrogen peroxide into highly reactive hydroxyl radicals capable of inducing widespread biomolecular damage

In animal experiments, increases in VEGF were observed at both 2 h and 1 month following TBI, indicating impaired vascularity in both the short and long term (120, 121)