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Title: Magnetic resonance imaging of the brain in adults with severe falciparum malaria.
Authors: Maude, Richard James
Barkhof, Frederik
Hassan, Mahtab Uddin
Ghose, Aniruddha
Hossain, Amir
Faiz, M Abul
Choudhury, Ehsan
Rashid, Rehnuma
Sayeed, Abdullah Abu
Prakaykaew Charunwatthana
ประกายแก้ว จรูญวรรธนะ
Plewes, Katherine
Kingston, Hugh
Rapeephan Rattanawongnara Maude
Kamolrat Silamut
กมลรัตน์ สิลมัฐ
Day,Nicholas Philip John
White, Nicholas John
Dondorp, Arjen Mattheus
Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research Unit.
Maude, Richard James
Keywords: Cerebral;Falciparum;MRI;Pathophysiology;Retinopathy;Open Access article
Issue Date: 9-May-2014
Citation: Maude RJ, Barkhof F, Hassan MU, Ghose A, Hossain A, Abul Faiz M. et al. Magnetic resonance imaging of the brain in adults with severe falciparum malaria. Malar J. 2014 May 9;13:177.
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.
ISSN: 1475-2875 (electronic)
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