Changes in optic nerve head blood flow in children with cerebral malaria and acute papilloedema.
OBJECTIVE
To investigate capillary blood flow in the optic nerve head (ONH) of children with cerebral malaria.


METHODS
Malawian children with cerebral malaria admitted to a paediatric research ward were examined by direct and indirect ophthalmoscopy. ONH blood flow was measured using laser Doppler flowmetry (LDF) in suitable patients. Mean blood volume and velocity were obtained from 30 to 60 s recordings from the temporal ONH and used to calculate blood flow. These were compared with admission variables, funduscopic findings and disease outcomes.


RESULTS
45 children with cerebral malaria had LDF recordings; 6 subsequently died and 5 survivors had neurological sequelae. 12 (27%) had papilloedema. The mean microvascular blood volume was higher in patients with papilloedema (3.28 v 2.54 arbitrary units, p = 0.002). The blood velocity correlated directly with haematocrit (r = 0.46, p = 0.001) and inversely with blood glucose (r = -0.49, p = 0.001).


CONCLUSIONS
The increase in ONH microvascular blood volume in papilloedema measured by LDF is consistent with current theories of pathogenesis of papilloedema. LDF has potential as a tool to distinguish papilloedema from pseudopapilloedematous disc swellings. The relationship between blood velocity and haematocrit may relate to levels of sequestration in cerebral malaria.
Beare
N A V
NA
St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK. nbeare@btinternet.com
Riva
C E
CE
Taylor
T E
TE
Molyneux
M E
ME
Kayira
K
K
White
V A
VA
Lewallen
S
S
Harding
S P
SP
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016779:Malaria, Cerebral / Q000150:complications / Q000473:pathology*; D008295:Malawi; D008297:Male; D009898:Optic Disk / Q000098:blood supply*; D010211:Papilledema / Q000209:etiology*; D011379:Prognosis; D012039:Regional Blood Flow