Brain Swelling and Death in Children with Cerebral Malaria
| Autor: | Simon J. Glover, Karl B. Seydel, Francis Muwalo, Terrie E. Taylor, Cowles A. Chilingulo, Samuel Kampondeni, Colleen A. Hammond, Danny A. Milner, Lindsay L. Fox, Michael J. Potchen, Gretchen L. Birbeck, Robert S. Heyderman, William G. Bradley, Clarissa Valim, Malcolm E. Molyneux |
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| Přispěvatelé: | University of St Andrews. School of Medicine |
| Rok vydání: | 2015 |
| Předmět: |
Male
Malawi Pediatrics medicine.medical_specialty Cerebral Malaria Cerebral NDAS Brain Edema R Medicine Article SDG 3 - Good Health and Well-being RA0421 RA0421 Public health. Hygiene. Preventive Medicine parasitic diseases medicine Humans Child Papilledema Pathological QM Coma medicine.diagnostic_test business.industry Brain Infant Magnetic resonance imaging Organ Size General Medicine medicine.disease Magnetic Resonance Imaging QM Human anatomy Malaria Surgery Cerebral Malaria Child Preschool Brain size RC0321 Female medicine.symptom business RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry Retinopathy |
| Zdroj: | New England Journal of Medicine. 372:1126-1137 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa1400116 |
| Popis: | Case fatality rates among African children with cerebral malaria remain in the range of 15 to 25%. The key pathogenetic processes and causes of death are unknown, but a combination of clinical observations and pathological findings suggests that increased brain volume leading to raised intracranial pressure may play a role. Magnetic resonance imaging (MRI) became available in Malawi in 2009, and we used it to investigate the role of brain swelling in the pathogenesis of fatal cerebral malaria in African children.We enrolled children who met a stringent definition of cerebral malaria (one that included the presence of retinopathy), characterized them in detail clinically, and obtained MRI scans on admission and daily thereafter while coma persisted.Of 348 children admitted with cerebral malaria (as defined by the World Health Organization), 168 met the inclusion criteria, underwent all investigations, and were included in the analysis. A total of 25 children (15%) died, 21 of whom (84%) had evidence of severe brain swelling on MRI at admission. In contrast, evidence of severe brain swelling was seen on MRI in 39 of 143 survivors (27%). Serial MRI scans showed evidence of decreasing brain volume in the survivors who had had brain swelling initially.Increased brain volume was seen in children who died from cerebral malaria but was uncommon in those who did not die from the disease, a finding that suggests that raised intracranial pressure may contribute to a fatal outcome. The natural history indicates that increased intracranial pressure is transient in survivors. (Funded by the National Institutes of Health and Wellcome Trust U.K.). |
| Databáze: | OpenAIRE |
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