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Magnetic resonance imaging of the brain in adults with severe falciparum malaria

Maude, Richard J., Barkhof, Frederik, Hassan, Mahtab, Ghose, Aniruddha, Hossain, Amir, Faiz, M. Abul, Choudhury, Ehsan, Rashid, Rehnuma, Sayeed, Abdullah, Charunwatthana, Prakaykaew, Plewes, Katherine, Kingston, Hugh W. F., Maude, Rapeephan, Silamut, Kamolrat, Day, Nicholas P. J., White, Nicholas J. and Dondorp, Arjen M. (2014). Magnetic resonance imaging of the brain in adults with severe falciparum malaria. Malaria Journal,13(1 - Article No. 177).

Document type: Journal Article
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IRMA ID 75039815xPUB548
Title Magnetic resonance imaging of the brain in adults with severe falciparum malaria
Author Maude, Richard J.
Barkhof, Frederik
Hassan, Mahtab
Ghose, Aniruddha
Hossain, Amir
Faiz, M. Abul
Choudhury, Ehsan
Rashid, Rehnuma
Sayeed, Abdullah
Charunwatthana, Prakaykaew
Plewes, Katherine
Kingston, Hugh W. F.
Maude, Rapeephan
Silamut, Kamolrat
Day, Nicholas P. J.
White, Nicholas J.
Dondorp, Arjen M.
Journal Name Malaria Journal
Publication Date 2014
Volume Number 13
Issue Number 1 - Article No. 177
ISSN 1475-2875   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84901237602
Total Pages 8
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background: Magnetic resonance imaging (MRI) allows detailed study of structural and functional changes in the
brain in patients with cerebral malaria.

Methods: In a prospective observational study in adult Bangladeshi patients with severe falciparum malaria, MRI
findings in the brain were correlated with clinical and laboratory parameters, retinal photography and optic nerve
sheath diameter (ONSD) ultrasound (a marker of intracranial pressure).

Results: Of 43 enrolled patients, 31 (72%) had coma and 12 (28%) died. MRI abnormalities were present in 79%
overall with mostly mild changes in a wide range of anatomical sites. There were no differences in MRI findings
between patients with cerebral and non-cerebral or fatal and non-fatal disease. Subtle diffuse cerebral swelling
was common (n = 22/43), but mostly without vasogenic oedema or raised intracranial pressure (ONSD). Also seen
were focal extracellular oedema (n = 11/43), cytotoxic oedema (n = 8/23) and mildly raised brain lactate on magnetic
resonance spectroscopy (n = 5/14). Abnormalities were much less prominent than previously described in Malawian
children. Retinal whitening was present in 36/43 (84%) patients and was more common and severe in patients
with coma.

Conclusion: Cerebral swelling is mild and not specific to coma or death in adult severe falciparum malaria. This
differs markedly from African children. Retinal whitening, reflecting heterogeneous obstruction of the central
nervous system microcirculation by sequestered parasites resulting in small patches of ischemia, is associated
with coma and this process is likely important in the pathogenesis.
Keywords MRI
Falciparum
Cerebral
Retinopathy
Pathophysiology
DOI http://dx.doi.org/10.1186/1475-2875-13-177   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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