HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Patankar, T. F. Articles by Prasad, S. R. Search for Related Content PubMed PubMed Citation Articles by Patankar, T. F. Articles by Prasad, S. R.

Adult Cerebral Malaria: Prognostic Importance of Imaging Findings and Correlation with Postmortem Findings¹

¹ From the Departments of Radiology (T.F.P., S.R.P.), Medicine (D.R.K.), and Pathology (A.P.D.), King Edward Memorial Hospital, Bombay, India; and Department of Imaging, P. D. Hinduja Hospital, Bombay, India (P.G.S.). From the 1998 RSNA scientific assembly. Received March 9, 2001; revision requested April 11; final revision received February 15, 2002; accepted April 6. Address correspondence to T.F.P., Woburn House, 30 Windy Hill Dr, Bolton BL3 4TH, England (e-mail: patankart@hotmail.com).

PURPOSE: To correlate imaging abnormalities, clinical features, and postmortem findings in patients with proved cerebral malaria.

MATERIALS AND METHODS: Twenty-one patients aged 17–50 years with cerebral malaria consented to undergo transverse nonenhanced (10-mm sections) and contrast material–enhanced (8-mm sections in posterior fossa and 10-mm sections in supratentorial region) CT on admission (n = 21) and on day 10 (n = 6), with thin sections (5 mm) obtained in the area of abnormality. All CT scans were evaluated for diffuse cerebral edema, focal parenchymal abnormalities, and hemorrhage. CT findings were categorized as normal, diffuse cerebral edema, and edema with thalamic hypoattenuation without or with cerebellar hypoattenuation. Spearman rank correlation test was performed.

RESULTS: Initial scans were normal in seven patients with mild disease (median Acute Physiology and Chronic Health Evaluation [APACHE] II score of 7, median Glasgow Coma Scale [GCS] score of 10), and all survived. Of eight patients with diffuse cerebral edema (GCS 8; median APACHE II, 21), six survived. Cerebral edema with thalamic and cerebellar white matter hypoattenuation was seen in five patients. All had GCS score of 6 or less, median APACHE II score of 26, and multiorgan failure; none survived. One patient (GCS = 6) had thalamic hypoattenuation without cerebellar lesions. He survived with mild residual hemiparesis. Diffuse petechial hemorrhages were seen in the cerebrum and cerebellum at autopsy in all seven patients who died. These petechial hemorrhages were not visualized on CT scans. CT findings did not correlate with degree of parasitemia.

CONCLUSION: CT findings correlate well with level of consciousness and severity of disease but underestimate the extent of disease at pathologic examination. A normal CT scan indicates a favorable outcome, whereas cerebellar hypoattenuation portends a poor outcome.

© RSNA, 2002

Index terms: Brain, CT, 143.12111, 143.12112, 153.12111, 153.12112 • Brain, edema, 10.259 • Brain, hemorrhage, 10.259 • Brain, infarction, 143.4352, 153.4352 • Malaria, 10.2079

This article has been cited by other articles:

				M.-F. Penet, A. Viola, S. Confort-Gouny, Y. Le Fur, G. Duhamel, F. Kober, D. Ibarrola, M. Izquierdo, N. Coltel, B. Gharib, et al. Imaging Experimental Cerebral Malaria In Vivo: Significant Role of Ischemic Brain Edema J. Neurosci., August 10, 2005; 25(32): 7352 - 7358. [Abstract] [Full Text] [PDF]