MRI findings in a cohort of brain injured survivors of pediatric cerebral malaria.

Am J Trop Med Hyg. 2013 Mar;88(3):542-6. doi: 10.4269/ajtmh.12-0538. Epub 2013 Jan 21.

Kampondeni SD, Potchen MJ, Beare NA, Seydel KB, Glover SJ, Taylor TE, Birbeck GL.

Blantyre Malaria Project, Blantyre, Malawi. s.kampo154@gmail.com

Abstract

Abstract. A prospective cohort study of retinopathy-confirmed cerebral malaria (CM) survivors identified 42 of 132 with neurologic sequelae. The 38 survivors with sequelae who were alive when magnetic resonance imaging (MRI) technology became available underwent brain MRIs. Common MRI abnormalities included periventricular T2 signal changes (53%), atrophy (47%), subcortical T2 signal changes (18%), and focal cortical defects (16%). The χ(2) tests assessed the relationship between chronic MRI findings, acute clinical and demographic data, and outcomes. Children who were older at the time of CM infection (P = 0.01) and those with isolated behavioral problems (P = 0.02) were more likely to have a normal MRI. Acute focal seizures were associated with atrophy (P = 0.05). Acute papilledema was associated with subcortical T2 signal changes (P = 0.02). Peripheral retinal whitening (P = 0.007) and a higher admission white blood cell count (P = 0.02) were associated with periventricular T2 signal changes. Chronic MRI findings suggest seizures, increased intracranial pressure, and microvascular ischemia contribute to clinically relevant structural brain injury in CM.

PMID:23339204

 

SUPPLEMENTARY:

The study by Kampondeni et al used Brain Magnetic resonance imaging(MRI) on survivors of Retinopathy positive pediatric CM  once they were discovered to have neurologic deficits on quarterly clinical evaluations. The link between PCM and later epilepsy has been established (Birbeck et al, Lancet Neurology). In this study, a. Structural Brain changes on MRI were investigated in survivors with neurlologic deficits, and b. Acute clinical findings were correlated with MRI changes at follow up

Table  1: MRI findings at follow-up in survivors of PCM with neurologic sequelae

Gretchen Birbeck-1

Table  2:Acute Admission PCM clinical findings that correlated with chronic MRI Brain findings

Gretchen Birbeck-2

This study has great relevance in planning the care of children in malaria-endemic countries. First, clinicians assessing children and adolescents who present with seizures, developmental delay and behavioral problems  should consider remote cerebral malaria as a potential cause. Secondly, specific findings during acute CM may be used to isolated children that will later need special care from  lasting structural brain damage.

Gretchen Birbeck-3

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