Neuroimaging findings in children with retinopathy-confirmed cerebral malaria.
OBJECTIVE
To describe brain CT findings in retinopathy-confirmed, paediatric cerebral malaria.


METHODS
In this outcomes study of paediatric cerebral malaria, a subset of children with protracted coma during initial presentation was scanned acutely. Survivors experiencing adverse neurological outcomes also underwent a head CT. All children had ophthalmological examination to confirm the presence of the retinopathy specific for cerebral malaria. Independent interpretation of CT images was provided by two neuroradiologists.


RESULTS
Acute brain CT findings in three children included diffuse oedema with obstructive hydrocephalus (2), acute cerebral infarctions in multiple large vessel distributions with secondary oedema and herniation (1), and oedema of thalamic grey matter (1). One child who was reportedly normal prior to admission had parenchymal atrophy suggestive of pre-existing CNS injury. Among 56 survivors (9-84 months old), 15 had adverse neurologic outcomes-11/15 had a follow-up head CT, 3/15 died and 1/15 refused CT. Follow-up head CTs obtained 7-18 months after the acute infection revealed focal and multifocal lobar atrophy correlating to regions affected by focal seizures during the acute infection (5/11). Other findings were communicating hydrocephalus (2/11), vermian atrophy (1/11) and normal studies (3/11).


CONCLUSIONS
The identification of pre-existing imaging abnormalities in acute cerebral malaria suggests that population-based studies are required to establish the rate and nature of incidental imaging abnormalities in Malawi. Children with focal seizures during acute cerebral malaria developed focal cortical atrophy in these regions at follow-up. Longitudinal studies are needed to further elucidate mechanisms of CNS injury and death in this common fatal disease.
Potchen
Michael J
MJ
Michigan State University, Department of Radiology, 184 Radiology Building, East Lansing, MI 48824-1303, USA. mjp@rad.msu.edu
Birbeck
Gretchen L
GL
Demarco
J Kevin
JK
Kampondeni
Sam D
SD
Beare
Nicholas
N
Molyneux
Malcolm E
ME
Taylor
Terrie E
TE
D002648:Child; D002675:Child, Preschool; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000175:diagnosis* / Q000401:mortality; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009485:Neuroradiography; D012174:Retinitis Pigmentosa / Q000000981:diagnostic imaging*