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In Vivo Tracking of Edema Development and Microvascular Pathology in a Model of Experimental Cerebral Malaria Using Magnetic Resonance Imaging
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Advancing Understanding of Cerebrovascular Hemodynamic Perturbations in Pediatric Cerebral Malaria Using a Modified

Nicole F O'Brien1, Madiha Q Raees2, Hunter J Wynkoop3

  • 1Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43502, USA. Nicole.obrien@Nationwidechildrens.org.

Neurocritical Care
|April 21, 2025
PubMed

Insights

Critical closing pressure (CrCP) was abnormal in many children with cerebral malaria (CM). A low diastolic closing margin (DCM) indicates a worse prognosis and may guide treatment for CM.

Area of Science:

  • Pediatric Neurology
  • Vascular Physiology
  • Infectious Diseases

Background:

  • Cerebral malaria (CM) is a major global health concern with high mortality.
  • Abnormal cerebral blood flow (CBF) in CM may contribute to poor outcomes.
  • Vascular tone alterations are implicated in CBF aberrations but are challenging to measure clinically.

Purpose of the Study:

  • To determine if Critical Closing Pressure (CrCP) and Diastolic Closing Margin (DCM) differ in children with CM compared to healthy controls.
  • To assess the association between DCM and patient outcomes in CM.

Main Methods:

  • Concurrent transcranial doppler ultrasound (TCD) and systemic blood pressure measurements were used to calculate CrCP and DCM in children with CM and controls.
  • Non-invasive estimates of intracranial pressure (ICP) and venous flow were measured.
  • Vascular tone was inferred, and differences in CrCP and DCM between groups were analyzed.

Main Results:

  • A significant proportion of children with CM exhibited CrCP values outside the normal range (more than 1 standard deviation below or above the mean).
  • Opening pressure (ICP estimate) and venous flows did not significantly differ between CM patients and controls.
  • A DCM less than 20 mmHg was associated with a 1.4-fold increased risk of poor outcome in CM patients (p=0.008).

Conclusions:

  • Abnormal CrCP is common in children with CM.
  • A low DCM is a significant predictor of poor prognosis in pediatric CM.
  • DCM may represent a potential therapeutic target for improving outcomes in CM.
Abstract

Keywords:
Cerebral malariaCrCPCritical closing pressureDiastolic closing marginOptimal cerebral perfusion pressureTCDTranscranial doppler ultrasound

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