Peri-Rolandic and Occipital Sparing Cortical Edema: A Prevalent MRI Finding in Pediatric Patients with Cerebral
Lorenna Vidal1,2, Alireza Zandifar3,4, Jorge Du Ub Kim3,5
1From the Department of Radiology (L.V., A.Z., J.D.U.K., L.O.T.-G., M.M.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania vidall@chop.edu.
Insights
Cerebral malaria in children often shows specific cortical edema patterns on MRI, sparing the occipital and peri-Rolandic regions. This pattern is linked to reduced brain swelling and better patient outcomes.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Cerebral malaria (CM) is a major cause of death and neurological disability in children in endemic regions.
- Brain swelling is a known predictor of mortality in pediatric CM.
- Understanding MRI patterns of cerebral edema is crucial for assessing disease severity and prognosis.
Purpose of the Study:
- To characterize cortical edema patterns in pediatric cerebral malaria using brain MRI.
- To determine the association between these edema patterns and clinical outcomes.
Main Methods:
- Retrospective review of brain MRI scans from 190 Malawian children with clinical CM.
- Assessment of cortical edema patterns, brain volume score, and other imaging findings by two neuroradiologists.
- Correlation of imaging findings with clinical outcomes at hospital discharge (mortality, neurological sequelae).
Main Results:
- Cortical edema was present in 163 (85.8%) children.
- The predominant pattern was diffuse cortical edema with relative occipital and peri-Rolandic sparing (63.2%).
- Occipital and peri-Rolandic sparing correlated inversely with brain volume score and improved outcomes.
Conclusions:
- Pediatric cerebral malaria exhibits a characteristic cortical edema pattern on MRI.
- This typical pattern relatively spares the occipital and peri-Rolandic areas.
- The degree of sparing is associated with disease severity and patient prognosis.
Background And Purpose:
Cerebral malaria (CM) is a leading cause of childhood mortality and neurologic morbidity in sub-Saharan Africa and South Asia and a strong association between diffuse brain swelling and mortality has been well-established. Our goal was to characterize patterns of cortical edema on brain MRI in children with CM and determine their association with patient outcomes.
Materials And Methods:
We retrospectively reviewed admission brain MR images obtained from Malawian children with clinical CM admitted at a single center from 2013-2019. Two neuroradiologists assessed the pattern of cortical edema on T1-, T2-, and DWI by using a consensus approach. The overall degree of brain volume (brain volume score [BVS]) and other brain imaging findings were also assessed, including focal signal changes in the basal ganglia, white matter, and posterior fossa. We evaluated the frequency and associations of these imaging findings with clinical outcomes at hospital discharge (deceased, alive with neurologic sequelae, or alive without neurologic sequelae).
Results:
We included admission brain MRI scans from 190 children with clinical CM. Cortical edema was identified in 163 MRIs. The predominant pattern of cortical edema was diffuse cortical involvement with relative sparing of the occipital and peri-Rolandic areas: 103 (63.2%) had this pattern, whereas 37 (22.7%) had sparing of the occipital cortex only, and 23 (14.1%) had generalized cortical edema without focal sparing. The presence of occipital and peri-Rolandic sparing inversely correlated with BVS (β = -0.26, P < .001) and outcomes (OR: 0.3; 95% CI: 0.1-0.6; P = .002).
Conclusions:
Pediatric CM is associated with a typical pattern of cortical edema that relatively spares the occipital and peri-Rolandic areas, which become progressively involved with more severe disease.
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