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Title: Magnetic resonance imaging of cerebral malaria patients reveals distinct pathogenetic processes in different parts of the brain
Authors: Sanjib Mohanty
Laura A. Benjamin
Megharay Majhi
Premanand Panda
Sam Kampondeni
Praveen K. Sahu
Akshaya Mohanty
Kishore C. Mahanta
Rajyabardhan Pattnaik
Rashmi R. Mohanty
Sonia Joshi
Anita Mohanty
Ian W. Turnbull
Arjen M. Dondorp
Terrie E. Taylor
Samuel C. Wassmer
Ispat General Hospital
University of Liverpool
Queen Elizabeth Central Hospital Malawi
Institute of Life Sciences India
North Manchester General Hospital
Mahidol University
Nuffield Department of Clinical Medicine
Michigan State University
University of Malawi College of Medicine
London School of Hygiene & Tropical Medicine
Keywords: Biochemistry, Genetics and Molecular Biology;Immunology and Microbiology
Issue Date: 1-May-2017
Citation: mSphere. Vol.2, No.3 (2017)
Abstract: © 2017 Mohanty et al. The mechanisms underlying the rapidly reversible brain swelling described in patients with cerebral malaria (CM) are unknown. Using a 1.5-Tesla (T) magnetic resonance imaging (MRI) scanner, we undertook an observational study in Rourkela, India, of 11 Indian patients hospitalized with CM and increased brain volume. Among the 11 cases, there were 5 adults and 6 children. All patients had reduced consciousness and various degrees of cortical swelling at baseline. The latter was predominately posterior in distribution. The findings on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps were consistent with vasogenic edema in all cases. Reversibility after 48 to 72 h was observed in > 90% of cases. DWI/ADC mismatch suggested the additional presence of cytotoxic edema in the basal nuclei of 5 patients; all of these had perfusion parameters consistent with vascular engorgement and not with ischemic infarcts. Our results suggest that an impairment of the blood-brain barrier is responsible for the brain swelling in CM. In 5 cases, vasogenic edema occurred in conjunction with changes in the basal nuclei consistent with venous congestion, likely to be caused by the sequestration of Plasmodium falciparum-infected erythrocytes. While both mechanisms have been individually postulated to play an important role in the development of CM, this is the first demonstration of their concurrent involvement in different parts of the brain. The clinical and radiological characteristics observed in the majority of our patients are consistent with posterior reversible encephalopathy syndrome (PRES), and we show for the first time a high frequency of PRES in the context of CM.
ISSN: 23795042
Appears in Collections:Scopus 2016-2017

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