Publication: Magnetic resonance imaging of cerebral malaria patients reveals distinct pathogenetic processes in different parts of the brain
Issued Date
2017-05-01
Resource Type
ISSN
23795042
Other identifier(s)
2-s2.0-85032715910
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
mSphere. Vol.2, No.3 (2017)
Suggested Citation
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 Magnetic resonance imaging of cerebral malaria patients reveals distinct pathogenetic processes in different parts of the brain. mSphere. Vol.2, No.3 (2017). doi:10.1128/mSphere.00193-17 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/41906
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Magnetic resonance imaging of cerebral malaria patients reveals distinct pathogenetic processes in different parts of the brain
Other Contributor(s)
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
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
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.