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Assessment of Cerebral Lateralization in Children using Functional Transcranial Doppler Ultrasound fTCD
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Transcranial Doppler Ultrasonography Provides Insights into Neurovascular Changes in Children with Cerebral Malaria

Nicole Fortier O'Brien1, Tshimanga Mutatshi Taty2, Melissa Moore-Clingenpeel3

  • 1Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.

The Journal of Pediatrics
|September 19, 2018
PubMed

Insights

Cerebral malaria in children causes diverse neurovascular changes, including hyperemia and low flow, impacting outcomes. Transcranial Doppler ultrasound (TCD) can identify these patterns to guide targeted therapies.

Area of Science:

  • Pediatric Neurology
  • Vascular Biology
  • Infectious Diseases

Background:

  • Cerebral malaria is a severe complication of Plasmodium falciparum infection in children.
  • Neurovascular dysfunction plays a critical role in the pathophysiology and outcomes of cerebral malaria.
  • Understanding these changes is crucial for developing effective treatments.

Purpose of the Study:

  • To evaluate neurovascular changes in pediatric patients with cerebral malaria using transcranial Doppler ultrasound (TCD).
  • To correlate specific TCD-identified neurovascular phenotypes with clinical outcomes, including mortality and neurologic sequelae.
  • To explore the potential of TCD as a tool for guiding individualized adjunctive therapies.

Main Methods:

  • Daily TCD examinations were performed on African children with cerebral malaria from enrollment through hospital day 8, discharge, or death.
  • Neurologic outcomes were assessed two weeks post-enrollment.
  • Comparison patients without cerebral malaria underwent TCD to establish a baseline.

Main Results:

  • Distinct TCD phenotypes were observed in children with cerebral malaria, including hyperemia (26%), low flow (28%), microvascular obstruction (22%), and vasospasm (13%).
  • Impaired cerebral autoregulation was common (80%) but improved over time.
  • Children with vasospasm had higher rates of sequelae, while those with low flow had higher mortality. Autoregulation differed significantly between those with and without normal neurologic outcomes.

Conclusions:

  • Specific neurovascular phenotypes identified by TCD in pediatric cerebral malaria are associated with distinct clinical outcomes.
  • TCD can differentiate patient groups, suggesting its utility in tailoring treatments.
  • Further validation of TCD-based phenotypic grouping may enable personalized adjunctive therapies to mitigate injury mechanisms in cerebral malaria.
Abstract

Keywords:
central nervous system infectioncerebral blood flowglobal healthtranscranial Doppler ultrasoundunder five mortality

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