Volume 87, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We aimed to use optic nerve sheath (ONS) ultrasound to determine the prevalence of raised intracranial pressure (ICP) in African children with cerebral malaria (CM); and if increased ONS diameter is associated with poor outcome. We measured ONS diameter in 101 children with CM and 11 children with malaria and impaired consciousness in Malawi. The prevalence of raised ICP detected by increased ONS diameter was 49%. Case fatality was similar in children with increased ONS diameter on admission (9/55) and those children without increased ONS diameter (11/57). Neurological sequelae were more common in those children with increased ONS diameter (7/46 versus 2/46, < 0.05). Lumbar puncture (LP) opening pressure was elevated in 95% of 46 children who underwent LP. In Malawian children with CM, raised ICP is less commonly detected by ONS ultrasound than LP. This study suggests that raised ICP is not universal in CM and that other mechanisms may account for coma.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Newton CR, Kirkham FJ, Winstanley PA, Pasvol G, Peshu N, Warrell DA, Marsh K, , 1991. Intracranial pressure in African children with cerebral malaria. Lancet 337: 573576.[Crossref] [Google Scholar]
  2. Waller D, Crawley J, Nosten F, Chapman D, Krishna S, Craddock C, Brewster D, White NJ, , 1991. Intracranial pressure in childhood cerebral malaria. Trans R Soc Trop Med Hyg 85: 362364.[Crossref] [Google Scholar]
  3. Lewallen S, Bakker H, Taylor TE, Wills BA, Courtright P, Molyneux ME, , 1996. Retinal findings predictive of outcome in cerebral malaria. Trans R Soc Trop Med Hyg 90: 144146.[Crossref] [Google Scholar]
  4. Beare NA, Southern C, Chalira C, Taylor TE, Molyneux ME, Harding SP, , 2004. Prognostic significance and course of retinopathy in children with severe malaria. Arch Ophthalmol 122: 11411147.[Crossref] [Google Scholar]
  5. Newton CR, Crawley J, Sowumni A, Waruiru C, Mwangi I, English M, Murphy S, Winstanley PA, Marsh K, Kirkham FJ, , 1997. Intracranial hypertension in Africans with cerebral malaria. Arch Dis Child 76: 219226.[Crossref] [Google Scholar]
  6. Hansen HC, Helmke K, , 1997. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 87: 3440.[Crossref] [Google Scholar]
  7. Helmke K, Hansen HC, , 1996. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study. Pediatr Radiol 26: 706710.[Crossref] [Google Scholar]
  8. Helmke K, Hansen HC, , 1996. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 26: 701705.[Crossref] [Google Scholar]
  9. Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A, , 2009. Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J 26: 630634.[Crossref] [Google Scholar]
  10. Blaivas M, Theodoro D, Sierzenski PR, , 2003. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 10: 376381.[Crossref] [Google Scholar]
  11. Major R, Girling S, Boyle A, , 2011. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J 28: 679681.[Crossref] [Google Scholar]
  12. Tsung JW, Blaivas M, Cooper A, Levick NR, , 2005. A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care 21: 9498.[Crossref] [Google Scholar]
  13. Newman WD, Hollman AS, Dutton GN, Carachi R, , 2002. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 86: 11091113.[Crossref] [Google Scholar]
  14. Malayeri AA, Bavarian S, Mehdizadeh M, , 2005. Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med 24: 143147.[Crossref] [Google Scholar]
  15. Beare NAV, Kampondeni S, Glover SJ, Molyneux E, Taylor TE, Harding SP, Molyneux ME, , 2008. Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Trop Med Int Health 13: 14001404.[Crossref] [Google Scholar]
  16. Smith A, Beare NAV, Musmba C, Lochhead J, Newton CRJ, Harding SP, , 2009. New classification of acute papilledema based on prognostic value of optic disc features in children with severe malaria. J Pediatr Neurol 7: 381389. [Google Scholar]
  17. Murphy S, Cserti-Gazdewich C, Dhabangi A, Musoke C, Nabukeera-Barungi N, Price D, King ME, Romero J, Noviski N, Dzik W, , 2011. Ultrasound findings in Plasmodium falciparum: a pilot study. Pediatr Crit Care Med 12: e58e63.[Crossref] [Google Scholar]
  18. Minns RA, Engleman HM, Stirling H, , 1989. Cerebrospinal fluid pressure in pyogenic meningitis. Arch Dis Child 64: 814820.[Crossref] [Google Scholar]
  19. Killer HE, Jaggi GP, Flammer NR, Huber AR, , 2006. The optic nerve: a new window into cerebrospinal fluid composition? Brain 129: 10271030.[Crossref] [Google Scholar]
  20. Killer HE, Jaggi GP, Miller NR, Huber AR, Landolt H, Mirinov A, Meyner P, Remonda L, , 2011. Cerebrospinal fluid dynamics between the basal cisterns and the sub-arachnoid space of the optic nerve in patients with papilledema. Br J Ophthalmol 95: 822827.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 14 Jul 2011
  • Accepted : 12 Mar 2012
  • Published online : 05 Dec 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error