PERTURBATIONS OF CEREBRAL HEMODYNAMICS IN KENYANS WITH CEREBRAL MALARIA

The mechanisms of death and neurologic sequelae in African children wi th cerebral malaria are undetermined. Because pathologic features are confined to the cerebral vasculature, perturbations in cerebral hemody namics may be responsible, We compared the transcranial Doppler findin gs in 50 children with cerebral malaria with those of 115 conscious Ke nyan children, In addition, 10 children with cerebral malaria were stu died during intracranial pressure monitoring and nine children were st udied during the agonal stages, In the children with cerebral malaria, cerebral blood flow velocity was increased in 30%, usually associated with seizures, Of the 11 children who developed neurologic sequelae, six had sonographic abnormalities associated with lateralizing deficit s, including four children with hemiparesis (in two children the contr alateral middle cerebral artery could not be insonated and two had tra nsient increases in blood flow velocity associated with seizures), In the children with severe intracranial hypertension, there was a signif icant linear relationship between the cerebral perfusion pressure and blood flow velocity, suggesting that autoregulation was impaired, Sono graphic features of progressive intracranial hypertension, were observ ed in three children with cerebral malaria who died, Perturbations of cerebral hemodynamics are associated with a poor outcome in Kenyan chi ldren with cerebral malaria.