Journal Article

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

Hossain, Amir, Dondorp, Arjen Mattheus, Kingston, Hugh, White, Nicholas John, Hassan, Mahtab Uddin, Plewes, Katherine, Silamut, Kamolrat, Ghose, Aniruddha, Choudhury, Ehsan, Abul Faiz, M, Sayeed, Abdullah Abu, Charunwatthana, Prakaykaew, Rashid, Rehnuma, Day, Nicholas Philip John, Maude, Rapeephan Rattanawongnara, Barkhof, Frederik, Maude, Richard James

2014

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adolescent / Adult / Aged / Bangladesh / Biomedical and Life Sciences / Biomedicine / Brain - diagnostic imaging / Brain - pathology / Brain research / Central nervous system / Complications and side effects / Diagnosis / Entomology / Female / Humans / Infectious Diseases / Magnetic Resonance Imaging / Malaria / Malaria, Cerebral - pathology / Male / Medical research / Medicine, Experimental / Microbiology / Middle Aged / Mortality / NMR / Nuclear magnetic resonance / Observational studies / Optic Nerve - diagnostic imaging / Optic Nerve - pathology / Parasites / Parasitology / Prospective Studies / Public Health / Radiography / Retina - pathology / Risk factors / Studies / Tropical Medicine / Ultrasonography / Vector-borne diseases / Young Adult