title: Children with retinopathy-negative cerebral malaria: a pathophysiologic puzzle.
abstract: BACKGROUND
  Cerebral malaria, defined as otherwise unexplained coma in a patient with circulating parasitemia, is a common disease in the developing world. The clinical diagnosis lacks specificity and children with other underlying causes of coma might be misdiagnosed as having cerebral malaria. The presence of malarial retinopathy can be used to differentiate children whose comas are caused by Plasmodium falciparum and its attendant pathophysiologies from those with other reasons for their abnormal mental status. Children with cerebral malaria who lack malarial retinopathy have not previously been described.
  
  
  METHODS
  All patients admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi, during a 12-month period with a clinical diagnosis of cerebral malaria were evaluated for the presence of malarial retinopathy. Thirty-two patients lacked retinopathy findings. Clinical, laboratory, and radiologic information data were collected.
  
  
  RESULTS
  Thirty-two cases of retinopathy-negative cerebral malaria are presented.
  
  
  CONCLUSIONS
  Children with retinopathy-negative cerebral malaria share a common clinical phenotype with lower rates of mortality compared with those who have malarial retinopathy. There are at least 4 possible pathophysiologic explanations for this common condition.
authors.affiliation: Department of Neurology and Ophthalmology, Michigan State University, International Neurologic and Psychiatric Epidemiology Program (INPEP), East Lansing, MI 48824, USA. douglas.postels@ht.msu.edu
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Postels
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000503:physiopathology*; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000503:physiopathology*; D008295:Malawi; D008297:Male; D018512:Parasitemia / Q000188:drug therapy / Q000503:physiopathology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000502:physiology*; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology
chemical_list: D000962:Antimalarials