Radiological findings in fulminant cerebral malaria: a rare neuroimaging presentation

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Cerebral malaria (CM), a severe Plasmodium falciparum complication, presents with neurological deficits and multiorgan dysfunction.
• MRI findings in adult CM, especially with rapid progression, are not well-documented.
• This case examines a fulminant CM presentation in an adult with initially normal CT findings.

Purpose of the Study:

• To report MRI findings in a severe adult case of cerebral malaria.
• To emphasize the diagnostic utility of MRI in adult CM.
• To correlate imaging findings with disease severity and prognosis.

Main Methods:

• A 54-year-old female patient with P. falciparum malaria presented with seizures and altered sensorium.
• Initial CT brain was unremarkable; subsequent MRI revealed bilateral T2/FLAIR hyperintensities and diffusion restriction in deep gray and white matter.
• The patient received intensive supportive care, including antimalarials, dialysis, and organ support.

Main Results:

• MRI demonstrated findings consistent with cytotoxic edema in the basal ganglia, thalami, centrum semiovale, and periventricular white matter.
• Despite prompt and comprehensive treatment, the patient experienced refractory multiorgan failure.
• The imaging findings reflect microvascular sequestration and cytotoxic injury characteristic of CM.

Conclusions:

• MRI is crucial for diagnosing adult CM when CT scans are inconclusive.
• Specific MRI patterns, including cytotoxic edema without hemorrhage, can aid in early diagnosis and risk stratification.
• Deep gray and white matter involvement on MRI correlates with CM severity and poor outcomes.