Related Experiment Video
Updated: Apr 24, 2026
In Vivo Tracking of Edema Development and Microvascular Pathology in a Model of Experimental Cerebral Malaria Using Magnetic Resonance Imaging
Published on: June 8, 2017
Brain MRI of children with retinopathy-negative cerebral malaria
Douglas G Postels1, Chenxi Li2, Gretchen L Birbeck2
1International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York douglas.postels@ht.msu.edu.
Abstract:
Our goals were to understand the brain magnetic resonance imaging (MRI) findings in children with retinopathy-negative cerebral malaria (CM) and investigate whether any findings on acute MRI were associated with adverse outcomes. We performed MRI scans on children admitted to the hospital in Blantyre, Malawi with clinically defined CM. Two hundred and seventeen children were imaged during the study period; 44 patients were malarial retinopathy-negative; and 173 patients were retinopathy-positive. We compared MRI findings in children with retinopathy-negative and retinopathy-positive CM. In children who were retinopathy-negative, we identified MRI variables that were associated with death and adverse neurologic outcomes. On multivariate analysis, cortical diffusion weighted imaging (DWI) abnormality and increased brain volume were strongly associated with neurologic morbidity in survivors. Investigations to explore the underlying pathophysiologic processes responsible for these MRI changes are warranted.
Insights
Brain MRI in children with cerebral malaria (CM) revealed that cortical diffusion weighted imaging (DWI) abnormalities and increased brain volume are linked to poor neurologic outcomes in survivors. Further research is needed.
Area of Science:
- Neuroimaging
- Pediatric Infectious Diseases
- Malariology
Background:
- Cerebral malaria (CM) is a severe complication of Plasmodium falciparum infection in children, often leading to significant neurological sequelae.
- Retinopathy is a clinical sign of CM, but its absence (retinopathy-negative CM) does not preclude severe brain involvement.
- Understanding brain magnetic resonance imaging (MRI) findings in retinopathy-negative CM is crucial for predicting outcomes.
Purpose of the Study:
- To characterize brain MRI findings in children with retinopathy-negative cerebral malaria (CM).
- To identify acute MRI findings associated with adverse outcomes, including death and neurological morbidity, in this patient group.
Main Methods:
- Prospective MRI scans were performed on 217 children with clinically defined CM in Blantyre, Malawi.
- Patients were categorized into retinopathy-negative (n=44) and retinopathy-positive (n=173) groups.
- Multivariate analysis was used to identify MRI variables associated with mortality and adverse neurological outcomes in survivors.
Main Results:
- MRI findings were compared between retinopathy-negative and retinopathy-positive CM groups.
- In retinopathy-negative CM, specific MRI variables were associated with increased risk of death and adverse neurological outcomes.
- Cortical diffusion-weighted imaging (DWI) abnormalities and increased brain volume on acute MRI were significantly associated with neurological morbidity in survivors.
Conclusions:
- Acute brain MRI can identify children with retinopathy-negative CM at higher risk for poor neurological outcomes.
- Cortical DWI abnormalities and increased brain volume are key imaging biomarkers for predicting neurologic morbidity in surviving children with CM.
- Further research into the pathophysiological mechanisms underlying these MRI changes is warranted to guide therapeutic strategies.
