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Intracranial hypertension in Africans with cerebral malaria
C R Newton1, J Crawley, A Sowumni
1Kenya Medical Research Institute, Clinical Research Centre, Kilifi, Kenya.
Insights
Intracranial hypertension is common in Kenyan children with cerebral malaria. Severe cases are linked to death or serious neurological issues, even with treatment.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum infection in children.
- The precise causes of mortality and neurological deficits in cerebral malaria remain unclear.
- Understanding intracranial pressure dynamics is crucial for managing severe pediatric malaria.
Purpose of the Study:
- To investigate the role of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in Kenyan children diagnosed with cerebral malaria.
- To determine the correlation between ICP/CPP levels and patient outcomes, including mortality and neurological sequelae.
Main Methods:
- Intracranial pressure (ICP) was continuously monitored in 23 Kenyan children with cerebral malaria.
- Cerebral perfusion pressure (CPP) was calculated based on ICP and mean arterial pressure.
- Patient outcomes, including survival and neurological status, were assessed.
Main Results:
- Four children presented with severe intracranial hypertension (ICP > 40 mm Hg, CPP < 40 mm Hg), with two deaths and two survivors experiencing severe neurological sequelae.
- Nine children had intermediate intracranial hypertension (ICP > 20 mm Hg, CPP < 50 mm Hg) and 10 had mild intracranial hypertension (maximum ICP 10-20 mm Hg); all survived without severe sequelae.
- Mannitol effectively reduced ICP in the intermediate group but did not prevent intractable intracranial hypertension in the severe group.
Conclusions:
- Intracranial hypertension is a significant clinical feature in Kenyan children suffering from cerebral malaria.
- Severe intracranial hypertension is strongly associated with poor outcomes, including death and severe neurological deficits.
- While mannitol may help manage moderate ICP elevations, it is insufficient for severe cases, highlighting the need for advanced management strategies.
Abstract:
The causes of death and neurological sequelae in African children with cerebral malaria are obscure. Intracranial pressure (ICP) was monitored and cerebral perfusion pressure (CPP) calculated in 23 Kenyan children with cerebral malaria. Four children had severe intracranial hypertension (ICP > 40 mm Hg, CPP < 40 mm Hg): two died, one with an ICP of 158 mm Hg and signs of transtentorial herniation, the other one with an ICP of 42 mm Hg and cardiorespiratory arrest. The other two survived with severe neurological sequelae. Nine had intermediate intracranial hypertension (ICP > 20 mm Hg, CPP < 50 mm Hg) and 10 had mild intracranial hypertension (maximum ICP 10-20 mm Hg); all survived without severe sequelae. Mannitol controlled the ICP in children with intermediate intracranial hypertension, but it did not prevent the development of intractable intracranial hypertension in children with severe intracranial hypertension. Intracranial hypertension is a feature of Kenyan children with cerebral malaria and severe intracranial hypertension is associated with a poor outcome.