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Published on: June 8, 2017
Neuroimaging findings in children with retinopathy-confirmed cerebral malaria
Michael J Potchen1, Gretchen L Birbeck, J Kevin Demarco
1Michigan State University, Department of Radiology, 184 Radiology Building, East Lansing, MI 48824-1303, USA. mjp@rad.msu.edu
Insights
Brain CT scans reveal significant findings in paediatric cerebral malaria, including edema, infarction, and atrophy. Children with seizures during infection developed focal cortical atrophy later, highlighting the need for longitudinal studies.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Paediatric cerebral malaria is a severe disease with potential neurological sequelae.
- Brain imaging is crucial for understanding the pathophysiology and long-term effects of cerebral malaria.
Purpose of the Study:
- To document brain computed tomography (CT) findings in children with confirmed cerebral malaria.
- To correlate acute CT findings with long-term neurological outcomes.
Main Methods:
- A subset of paediatric cerebral malaria patients with prolonged coma underwent acute head CT scans.
- Survivors with adverse neurological outcomes had follow-up head CTs.
- Ophthalmological examinations confirmed malaria retinopathy, and CT interpretations were done by two independent neuroradiologists.
Main Results:
- Acute CT scans showed diffuse edema, obstructive hydrocephalus, cerebral infarctions, and thalamic gray matter edema.
- One patient had pre-existing atrophy suggesting prior central nervous system (CNS) injury.
- Follow-up CTs in survivors revealed focal and multifocal lobar atrophy in children who experienced focal seizures during acute infection.
Conclusions:
- Pre-existing imaging abnormalities in cerebral malaria warrant population-based studies.
- Focal cortical atrophy developed in regions affected by seizures during acute infection.
- Longitudinal studies are essential to understand CNS injury mechanisms and mortality in cerebral malaria.
Purpose:
To describe brain CT findings in retinopathy-confirmed, paediatric cerebral malaria.
Materials And Methods:
In this outcomes study of paediatric cerebral malaria, a subset of children with protracted coma during initial presentation was scanned acutely. Survivors experiencing adverse neurological outcomes also underwent a head CT. All children had ophthalmological examination to confirm the presence of the retinopathy specific for cerebral malaria. Independent interpretation of CT images was provided by two neuroradiologists.
Results:
Acute brain CT findings in three children included diffuse oedema with obstructive hydrocephalus (2), acute cerebral infarctions in multiple large vessel distributions with secondary oedema and herniation (1), and oedema of thalamic grey matter (1). One child who was reportedly normal prior to admission had parenchymal atrophy suggestive of pre-existing CNS injury. Among 56 survivors (9-84 months old), 15 had adverse neurologic outcomes-11/15 had a follow-up head CT, 3/15 died and 1/15 refused CT. Follow-up head CTs obtained 7-18 months after the acute infection revealed focal and multifocal lobar atrophy correlating to regions affected by focal seizures during the acute infection (5/11). Other findings were communicating hydrocephalus (2/11), vermian atrophy (1/11) and normal studies (3/11).
Conclusions:
The identification of pre-existing imaging abnormalities in acute cerebral malaria suggests that population-based studies are required to establish the rate and nature of incidental imaging abnormalities in Malawi. Children with focal seizures during acute cerebral malaria developed focal cortical atrophy in these regions at follow-up. Longitudinal studies are needed to further elucidate mechanisms of CNS injury and death in this common fatal disease.
