Do patients with cerebral malaria have cerebral oedema? A computed tomography study

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Severe cerebral malaria is a life-threatening complication of Plasmodium falciparum infection.
• The neurological manifestations of cerebral malaria, including coma, are not fully understood.
• The role of cerebral edema in the pathophysiology of cerebral malaria requires further investigation.

Purpose of the Study:

• To investigate the presence and significance of cerebral edema in patients with severe cerebral malaria using computed tomography (CT).
• To determine if CT findings correlate with clinical outcomes, including mortality and neurological deficits.

Main Methods:

• Computed tomography (CT) scans of the brain were performed on 10 patients diagnosed with severe cerebral malaria.
• Clinical data, including neurological status and outcome (survival or death), were collected for all patients.
• Follow-up CT scans were obtained in some surviving patients during convalescence.

Main Results:

• Cerebral edema was detected in only 2 out of 5 fatal cases.
• Subtle areas of altered density, not associated with focal neurological signs, were observed in 4 patients.
• These altered densities persisted in follow-up scans for 2 survivors.
• Four patients, including one fatality, had entirely normal CT scans.
• Cerebral edema was not consistently observed in patients with severe cerebral malaria, even in fatal cases.

Conclusions:

• Cerebral edema can be present in severe cerebral malaria but is not a universal finding.
• The absence of consistent cerebral edema on CT scans suggests that other pathophysiological mechanisms may contribute to coma in severe cerebral malaria.
• CT imaging may not always reveal the cause of coma in patients with severe cerebral malaria.