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Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
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Cerebral Metabolic Crisis in Pediatric Cerebral Malaria

Nicole F O'Brien1, Karen Chetcuti2, Yudy Fonseca3

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

Journal of Pediatric Intensive Care
|November 16, 2023
PubMed

Insights

Cerebral metabolic energy crisis (CMEC) is common in children with cerebral malaria (CM), with over half experiencing ischemic CMEC. This subtype is linked to poorer cerebral blood flow and worse neurological outcomes, suggesting potential therapeutic targets.

Area of Science:

  • Neurology
  • Pediatrics
  • Infectious Diseases

Background:

  • Cerebral metabolic energy crisis (CMEC), indicated by a high cerebrospinal fluid (CSF) lactate:pyruvate ratio (LPR), is linked to poor neurological outcomes.
  • Cerebral malaria (CM) is a major cause of childhood mortality and neurodisability globally.
  • The occurrence and characteristics of CMEC in pediatric CM patients remain underexplored.

Purpose of the Study:

  • To determine the frequency of CMEC in children with CM.
  • To differentiate between ischemic and nonischemic CMEC subtypes.
  • To investigate the association between CMEC subtypes and cerebral blood flow, as well as neurological outcomes.

Main Methods:

  • Fifty-three children diagnosed with CM were enrolled in the study.
  • CSF lactate and pyruvate levels were analyzed to calculate the LPR.
  • Transcranial Doppler ultrasound was used to assess cerebral blood flow velocities.

Main Results:

  • All 53 pediatric CM patients exhibited CMEC, with a median CSF LPR of 72.9.
  • Half of the patients were classified with ischemic CMEC (median LPR 85) and half with nonischemic CMEC (median LPR 60).
  • Ischemic CMEC was associated with significantly higher rates of low cerebral blood flow or vasospasm (73% vs. 20%) and poorer neurological outcomes (46% vs. 22%) compared to nonischemic CMEC.

Conclusions:

  • CMEC is a near-universal finding in pediatric cerebral malaria.
  • Ischemic and nonischemic CMEC subtypes have distinct associations with cerebral hemodynamics and neurological outcomes.
  • Targeting the underlying mechanisms of these CMEC subtypes may offer avenues for novel adjunctive therapies in pediatric CM.

Keywords:
Doppler sonographybrain blood flowbrain disorderscerebral blood flowcerebral malariametabolictranscranial

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