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Brain swelling and ischaemia in Kenyans with cerebral malaria
C R Newton1, N Peshu, B Kendall
1Kilifi Research Unit, Kenya Medical Research Institute.
Insights
Computed tomography revealed brain swelling and intracranial hypertension in unconscious children with cerebral malaria. This brain injury may stem from systemic factors, not just the direct effects of the disease.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum infection.
- Neurological sequelae are common in children recovering from cerebral malaria.
- The underlying causes of intracranial hypertension and brain injury in this condition require further elucidation.
Purpose of the Study:
- To investigate the causes of intracranial hypertension and neurological sequelae in Kenyan children recovering from cerebral malaria using computed tomography (CT).
- To identify patterns of brain damage associated with cerebral malaria and its complications.
Main Methods:
- Computed tomography (CT) scans were performed on 14 unconscious Kenyan children with cerebral malaria.
- Seven children underwent a follow-up CT scan 12-120 days later.
- Intracranial pressure and cerebral perfusion pressure were monitored in some participants.
Main Results:
- Brain swelling, characterized by loss of cerebrospinal fluid spaces, was observed in six children.
- Severe intracranial hypertension was present in children with significant brain swelling.
- Widespread low-density areas suggestive of ischemic damage were found in four children with brain swelling.
- Patterns of damage were consistent with reduced cerebral perfusion pressure, hypoglycemia, or status epilepticus.
Conclusions:
- Brain injury in cerebral malaria may result from secondary systemic and intracranial factors, in addition to direct intravascular sequestration.
- These factors contribute to intracranial hypertension and neurological deficits observed in affected children.
- CT imaging is valuable in assessing brain injury patterns in pediatric cerebral malaria.
Abstract:
Computed tomography was performed on 14 unconscious Kenyan children recovering from cerebral malaria (seven of whom had another scan 12-120 days later) to elucidate the cause of intracranial hypertension and neurological sequelae. Brain swelling, defined as a loss of cerebrospinal fluid spaces, was documented in six children, while a further two had conspicuously small ventricles only. There was severe intracranial hypertension in the two children with definite brain swelling in whom intracranial pressure was monitored. There was no evidence of acute hydrocephalus or vasogenic oedema. Four children with brain swelling also had widespread low density areas suggestive of ischaemic damage. The patterns of damage were not uniform but were consistent with a critical reduction in cerebral perfusion pressure (which was documented in the two in whom this was monitored), hypoglycaemia, or status epilepticus. All four had serious neurological sequelae. These data suggest that brain injury in cerebral malaria may be due in part to secondary systemic and intracranial factors as well as to the direct effect of intravascular sequestration.