title: Acute brain MRI findings in 120 Malawian children with cerebral malaria: new insights into an ancient disease.
abstract: OBJECTIVE
  There have been few neuroimaging studies of pediatric CM, a common often fatal tropical condition. We undertook a prospective study of pediatric CM to better characterize the MRI features of this syndrome, comparing findings in children meeting a stringent definition of CM with those in a control group who were infected with malaria but who were likely to have a nonmalarial cause of coma.
  
  
  METHODS
  Consecutive children admitted with traditionally defined CM (parasitemia, coma, and no other coma etiology evident) were eligible for this study. The presence or absence of malaria retinopathy was determined. MRI findings in children with ret+ CM (patients) were compared with those with ret- CM (controls). Two radiologists blinded to retinopathy status jointly developed a scoring procedure for image interpretation and provided independent reviews. MRI findings were compared between patients with and without retinopathy, to assess the specificity of changes for patients with very strictly defined CM.
  
  
  RESULTS
  Of 152 children with clinically defined CM, 120 were ret+, and 32 were ret-. Abnormalities much more common in the patients with ret+ CM were markedly increased brain volume; abnormal T2 signal intensity; and DWI abnormalities in the cortical, deep gray, and white matter structures. Focal abnormalities rarely respected arterial vascular distributions. Most of the findings in the more clinically heterogeneous ret- group were normal, and none of the abnormalities noted were more prevalent in controls.
  
  
  CONCLUSIONS
  Distinctive MRI findings present in patients meeting a stringent definition of CM may offer insights into disease pathogenesis and treatment.
authors.affiliation: Department of Radiology, Michigan State University, East Lansing, Michigan, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Potchen
authors.forename: S D
authors.initials: SD
authors.lastname: Kampondeni
authors.forename: K B
authors.initials: KB
authors.lastname: Seydel
authors.forename: G L
authors.initials: GL
authors.lastname: Birbeck
authors.forename: C A
authors.initials: CA
authors.lastname: Hammond
authors.forename: W G
authors.initials: WG
authors.lastname: Bradley
authors.forename: J K
authors.initials: JK
authors.lastname: DeMarco
authors.forename: S J
authors.initials: SJ
authors.lastname: Glover
authors.forename: J O
authors.initials: JO
authors.lastname: Ugorji
authors.forename: M T
authors.initials: MT
authors.lastname: Latourette
authors.forename: J E
authors.initials: JE
authors.lastname: Siebert
authors.forename: M E
authors.initials: ME
authors.lastname: Molyneux
authors.forename: T E
authors.initials: TE
authors.lastname: Taylor
mesh_terms: D000208:Acute Disease; D001921:Brain / Q000473:pathology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D016779:Malaria, Cerebral / Q000453:epidemiology* / Q000473:pathology*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity