Publication: Magnetic resonance imaging of the brain in adults with severe falciparum malaria.
Accepted Date
2014-05-02
Issued Date
2014-05-09
Copyright Date
2014
Resource Type
Language
eng
ISSN
1475-2875 (electronic)
Rights
Mahidol University
Rights Holder(s)
BioMed Central
Bibliographic 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.
Suggested Citation
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 Magnetic resonance imaging of the brain in adults with severe falciparum malaria.. 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.. doi:10.1186/1475-2875-13-177. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/741
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Title
Magnetic resonance imaging of the brain in adults with severe falciparum malaria.
Author(s)
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
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
Corresponding Author(s)
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.