Cerebral complications of a malarial infection is estimated to occur in ~2% of patients with acute Plasmodium falciparum infection.
Patients may present with a coma on a background of malarial infection.
It can at times be characerised by diffuse petechial haemorrhages on post mortem pathological specimens which are often difficult to identifiy retropsecitvely on imaging 1-2.
The haemorhages are thought to occur when cerebral capillaries and small veins are occluded by infected erythrocytes. The same pathological process may also lead to areas or infarction.
Imaging features on its own are often nonspecific 7. Most are based on case reports and small case series.
CT findings do not appear to not correlate with the degree of parasitaemia and can sometimes be normal 1.
Reported features include
- evidence of cerebral oedema +/- thalamic and cerebellar white matter hypoattenuation 1
Described features on case reports include
- cortical infarcts or hyperintense areas of white matter on T2 and FLAIR sequences 3 ; these have been described in bilateral periventricular white matter, corpus callosum, occipital subcortex, and bilateral thalamic regions 8
- acute haemorrhage(s) adjacent to areas of infarction 6
- some authors advocate the use of susceptibility weighted imaging (SWI) as potentially promising method to detect microhaemorrhages 2
It is often associated with a high mortality rate (20-50%). However, those patients who survive often have a full recovery with minimal or no long-term sequelae.
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- 2. Nickerson JP, Tong KA, Raghavan R. Imaging cerebral malaria with a susceptibility-weighted MR sequence. AJNR Am J Neuroradiol. 2009;30 (6): e85-6. doi:10.3174/ajnr.A1568 - Pubmed citation
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- 4. Gupta S, Patel K. Case series: MRI features in cerebral malaria. Indian J Radiol Imaging. 2008;18 (3): 224-6. doi:10.4103/0971-3026.41832 - Free text at pubmed - Pubmed citation
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- 6. Millan JM, San millan JM, Muñoz M et-al. CNS complications in acute malaria: MR findings. AJNR Am J Neuroradiol. 14 (2): 493-4. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 7. Sakai O, Barest GD. Diffusion-weighted imaging of cerebral malaria. J Neuroimaging. 2005;15 (3): 278-80. doi:10.1177/1051228405277341 - Pubmed citation
- 8. Yadav P, Sharma R, Kumar S et-al. Magnetic resonance features of cerebral malaria. Acta Radiol. 2008;49 (5): 566-9. doi:10.1080/02841850802020476 - Pubmed citation