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Title: Magnetic resonance imaging of the brain in adults with severe falciparum malaria
Authors: Richard James Maude
Frederik Barkhof
Mahtab Uddin Hassan
Aniruddha Ghose
Amir Hossain
M. Abul Faiz
Ehsan Choudhury
Rehnuma Rashid
Abdullah Abu Sayeed
Prakaykaew Charunwatthana
Katherine Plewes
Hugh Kingston
Rapeephan Rattanawongnara Maude
Kamolrat Silamut
Nicholas Philip John Day
Nicholas John White
Arjen Mattheus Dondorp
Nuffield Department of Clinical Medicine
Mahidol University
University of Edinburgh, College of Medicine and Veterinary Medicine
VU University Medical Center
Chittagong Medical College Hospital
Dev Care Foundation
Centre for Specialized Care and Research
Chevron Laboratory
Menzies School of Health Research
Keywords: Immunology and Microbiology;Medicine
Issue Date: 9-May-2014
Citation: Malaria Journal. Vol.13, No.1 (2014)
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. © 2014 Maude et al. licensee BioMed Central Ltd.
ISSN: 14752875
Appears in Collections:Scopus 2011-2015

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