Cited by 404Malaria Research and ControlInfectious Encephalopathies and EncephalitisBacterial Infections and Vaccines

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Brain Swelling and Death in Children with Cerebral Malaria

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Seydel, Karl B., Kampondeni, Samuel D., Valim, Clarissa, Potchen, Michael J., Milner, Danny A., Muwalo, Francis W., Birbeck, Gretchen L., Bradley, William G., Fox, Lindsay L., Glover, Simon J., Hammond, Colleen A., Heyderman, Robert S., Chilingulo, Cowles A., Molyneux, Malcolm E., Taylor, Terrie E.·2015·New England Journal of Medicine

DOI 10.1056/nejmoa1400116PMC PMC4450675

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Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.).

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Authors: Seydel, K. B., Kampondeni, S. D., Valim, C., Potchen, M. J., Milner, D. A., Muwalo, F. W., Birbeck, G. L., Bradley, W. G., Fox, L. L., Glover, S. J., Hammond, C. A., Heyderman, R. S., Chilingulo, C. A., Molyneux, M. E., & Taylor, T. E.
Affiliations: University of Malawi (MW)
Harvard University (US)
Michigan State University (US)
Brigham and Women's Hospital (US)
University of California San Diego (US)
ORCID: Seydel, Karl B.
Valim, Clarissa
Potchen, Michael J.
Milner, Danny A.
Birbeck, Gretchen L.
Heyderman, Robert S.
Chilingulo, Cowles A.
Molyneux, Malcolm E.
Taylor, Terrie E.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2015-03-19
Volume: 372
Issue: 12
Pages: 1126-1137
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1400116
PMC: PMC4450675
OpenAlex: W2118846793
Cited by: 404
References: 43
Citations by year: 2026: 21 · 2025: 44 · 2024: 24 · 2023: 42 · 2022: 42 · 2021: 36 · 2020: 42 · 2019: 35 · 2018: 41 · 2017: 33 · 2016: 31 · 2015: 13
FWCI: 42.09
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
UCL Discovery (University College London) (submittedVersion)
St Andrews Research Repository (St Andrews Research Repository) (submittedVersion)
Funders: Michigan State University
Wellcome Trust (101113)
National Institutes of Health
College of Engineering, Michigan State University
National Institute of Allergy and Infectious Diseases (R01AI034969)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords: cerebral malaria, cerebral edema, intracranial pressure, case fatality, pediatric malaria, retinopathy, brain volume, coma, natural history (disease)
MeSH terms: Brain, Brain Edema, Child, Child, Preschool, Female, Humans, Infant, Magnetic Resonance Imaging, Malawi, Male, Organ Size, Papilledema, Malaria, Cerebral

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Brain Swelling and Death in Children with Cerebral Malaria

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