Dataset Information

Magnetic resonance imaging of the brain in adults with severe falciparum malaria.

ABSTRACT:

Background

Magnetic resonance imaging (MRI) allows detailed study of structural and functional changes in the brain in patients with cerebral malaria.

Methods

In a prospective observational study in adult Bangladeshi patients with severe falciparum malaria, MRI findings in the brain were correlated with clinical and laboratory parameters, retinal photography and optic nerve sheath diameter (ONSD) ultrasound (a marker of intracranial pressure).

Results

Of 43 enrolled patients, 31 (72%) had coma and 12 (28%) died. MRI abnormalities were present in 79% overall with mostly mild changes in a wide range of anatomical sites. There were no differences in MRI findings between patients with cerebral and non-cerebral or fatal and non-fatal disease. Subtle diffuse cerebral swelling was common (n?=?22/43), but mostly without vasogenic oedema or raised intracranial pressure (ONSD). Also seen were focal extracellular oedema (n?=?11/43), cytotoxic oedema (n?=?8/23) and mildly raised brain lactate on magnetic resonance spectroscopy (n?=?5/14). Abnormalities were much less prominent than previously described in Malawian children. Retinal whitening was present in 36/43 (84%) patients and was more common and severe in patients with coma.

Conclusion

Cerebral swelling is mild and not specific to coma or death in adult severe falciparum malaria. This differs markedly from African children. Retinal whitening, reflecting heterogeneous obstruction of the central nervous system microcirculation by sequestered parasites resulting in small patches of ischemia, is associated with coma and this process is likely important in the pathogenesis.

SUBMITTER: Maude RJ

PROVIDER: S-EPMC4024626 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Publications

Magnetic resonance imaging of the brain in adults with severe falciparum malaria.

Maude Richard James RJ Barkhof Frederik F Hassan Mahtab Uddin MU Ghose Aniruddha A Hossain Amir A Abul Faiz M M Choudhury Ehsan E Rashid Rehnuma R Abu Sayeed Abdullah A Charunwatthana Prakaykaew P Plewes Katherine K Kingston Hugh H Maude Rapeephan Rattanawongnara RR Silamut Kamolrat K Day Nicholas Philip John NP White Nicholas John NJ Dondorp Arjen Mattheus AM

Malaria journal 20140509

<h4>Background</h4>Magnetic resonance imaging (MRI) allows detailed study of structural and functional changes in the brain in patients with cerebral malaria.<h4>Methods</h4>In a prospective observational study in adult Bangladeshi patients with severe falciparum malaria, MRI findings in the brain were correlated with clinical and laboratory parameters, retinal photography and optic nerve sheath diameter (ONSD) ultrasound (a marker of intracranial pressure).<h4>Results</h4>Of 43 enrolled patient ...[more]

PMID: 24884982

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Dataset Information

Magnetic resonance imaging of the brain in adults with severe falciparum malaria.

Background

Methods

Results

Conclusion

Publications

Magnetic resonance imaging of the brain in adults with severe falciparum malaria.

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