Brain MRI of Children with Retinopathy-Negative Cerebral Malaria

Douglas G. Postels International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Chenxi Li International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Gretchen L. Birbeck International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Terrie E. Taylor International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Karl B. Seydel International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Sam D. Kampondeni International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Simon J. Glover International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Michael J. Potchen International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology, University of Rochester, Rochester, New York; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Anatomy, University of St. Andrews, St. Andrews, Scotland; Department of Imaging Sciences, University of Rochester, Rochester, New York

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Our goals were to understand the brain magnetic resonance imaging (MRI) findings in children with retinopathy-negative cerebral malaria (CM) and investigate whether any findings on acute MRI were associated with adverse outcomes. We performed MRI scans on children admitted to the hospital in Blantyre, Malawi with clinically defined CM. Two hundred and seventeen children were imaged during the study period; 44 patients were malarial retinopathy-negative; and 173 patients were retinopathy-positive. We compared MRI findings in children with retinopathy-negative and retinopathy-positive CM. In children who were retinopathy-negative, we identified MRI variables that were associated with death and adverse neurologic outcomes. On multivariate analysis, cortical diffusion weighted imaging (DWI) abnormality and increased brain volume were strongly associated with neurologic morbidity in survivors. Investigations to explore the underlying pathophysiologic processes responsible for these MRI changes are warranted.

Author Notes

* Address correspondence to Douglas G. Postels, International Neurologic and Psychiatric Epidemiology Program, Michigan State University, 909 Fee Road, 324 West Fee Hall, East Lansing, MI 48824. E-mail: douglas.postels@ht.msu.edu

Financial support: This study was supported by National Institutes of Health Grant 5R01AI034969.

Authors' addresses: Douglas G. Postels, International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI, E-mail: douglas.postels@ht.msu.edu. Chenxi Li, Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, E-mail: cli@epi.msu.edu. Gretchen L. Birbeck, Department of Neurology, University of Rochester, Rochester, NY, E-mail: Gretchen_Birbeck@URMC.Rochester.edu. Terrie E. Taylor, Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, MI, and Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, E-mail: ttmalawi@msu.edu. Karl B. Seydel, Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, MI, E-mail: seydel@msu.edu. Sam D. Kampondeni, Department of Radiology, University of Malawi College of Medicine, Blantyre, Malawi, E-mail: s.kampo154@gmail.com. Simon J. Glover, Anatomy Department, School of Medicine, University of St. Andrews, St. Andrews, Scotland, E-mail: simontheeyeman@hotmail.com. Michael J. Potchen, Department of Imaging Sciences, University of Rochester, Rochester, NY, E-mail: Michael_Potchen@URMC.Rochester.edu.

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