BRAIN-SWELLING AND ISCHEMIA IN KENYANS WITH CEREBRAL MALARIA

Computed tomography was performed on 14 unconscious Kenyan children re covering from cerebral malaria (seven of whom had another scan 12-120 days later) to elucidate the cause of intracranial hypertension and ne urological sequelae. Brain swelling, defined as a loss of cerebrospina l fluid spaces, was documented in six children, while a further two ha d conspicuously small ventricles only. There was severe intracranial h ypertension in the two children with definite brain swelling in whom i ntracranial pressure was monitored. There was no evidence of acute hyd rocephalus or vasogenic oedema. Four children with brain swelling also had widespread low density areas suggestive of ischaemic damage. The patterns of damage were not uniform but were consistent with a critica l reduction in cerebral perfusion pressure (which was documented in th e two in whom this was monitored), hypoglycaemia, or status epilepticu s. All four had serious neurological sequelae. These data suggest that brain injury in cerebral malaria may be due in part to secondary syst emic and intracranial factors as well as to the direct effect of intra vascular sequestration.