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Updated: Oct 25, 2025
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
Cerebral malaria: insight into pathology from optical coherence tomography
Zhanhan Tu1, Jack Gormley2, Viral Sheth1
1Department of Neuroscience, Psychology and Behaviour, Ulverscroft Eye Unit, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
Hand-held optical coherence tomography (HH-OCT) reveals structural retinal changes in malarial retinopathy (MR). These changes, including hyper-reflective areas, can lead to retinal thinning and may help predict neurological deficits in children.
Area of Science:
- Ophthalmology
- Malariology
- Medical Imaging
Background:
- Malarial retinopathy (MR) is a serious complication of Plasmodium falciparum malaria.
- Assessing structural retinal changes in MR is crucial for understanding disease progression and potential long-term neurological effects.
- Current diagnostic methods may not fully capture the dynamic structural changes occurring in the retina during and after malaria infection.
Purpose of the Study:
- To investigate structural retinal changes in children with malarial retinopathy (MR) using hand-held optical coherence tomography (HH-OCT).
- To evaluate the diagnostic potential of HH-OCT in assessing MR.
- To correlate OCT findings with clinical outcomes and explore their predictive value for neurological deficits.
Main Methods:
- Children with MR (n=43) underwent ophthalmoscopy, fluorescein angiography, and HH-OCT during admission, 1-month, and 1-year post-discharge.
- Control groups included comatose patients without malaria (n=6) and age/sex-matched healthy children (n=43).
- OCT findings, including hyper-reflective areas (HRAs), cotton wool spots, abnormal hyper-reflective dots, hyper-reflective vessel walls, and intra-retinal cysts, were analyzed and compared with retinal layer thicknesses.
Main Results:
- HH-OCT identified hyper-reflective areas (HRAs) in the inner retina of 81% of MR patients, corresponding to ischaemic retinal whitening.
- Abnormal hyper-reflective dots and hyper-reflective vessel walls were observed in 93% and 84% of MR patients, respectively.
- Vascular changes and cysts resolved rapidly, while HRAs progressed to retinal thinning at 1 month (p=0.027) and 1 year (p=0.009), indicating post-ischemic atrophy.
Conclusions:
- HH-OCT effectively visualizes structural retinal changes in MR, distinguishing ischaemic retinal whitening from cotton wool spots.
- Vascular hyper-reflectivity may indicate parasitized erythrocyte sequestration, a key feature of cerebral malaria (CM).
- HH-OCT shows potential for monitoring MR patients, assessing treatment response, and predicting neurological deficits in CM survivors, potentially mirroring mechanisms of cerebral atrophy.
