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Cerebral malaria

Case contributed by Dr Mona Mohamed Naguib Sabala

Presentation

The patient presented with fever, confusion and altered level of consciousness after recent travel to Nigeria.

Patient Data

Age: 50 years
Gender: Male
MRI

MRI with contrast revealed a patchy faint high signal intensity on T2 and FLAIR images mainly in the splenium of the corpus callosum. There is corresponding diffusion restriction on DWI/ADC sequences (on ADC particularly, there is also restriction in the head of the corpus callosum). However, there is no significant enhancement post IV gadolinium injection. 

Annotated image

Annotated images to show the signal abnormalities on T2, FLAIR, DWI and ADC sequences.

Case Discussion

Cerebral malaria is a life-threatening complication of infection with Plasmodium falciparum.  In adults, cerebral malaria is part of a multi-organ disease.

The clinical hallmark of cerebral malaria is impaired consciousness, with coma the most severe manifestation. Without treatment, cerebral malaria is invariably fatal, especially in children. In adults, however, mortality is lower if they are properly treated.

The radiological findings range from normal, cerebral edema and focal or diffuse signal changes in the centrum semiovale, corpus callosum, thalamus and insular cortex. The hyperintensities on T2 and FLAIR images are considered to be due to edema, ischemia or toxic injury. DWI/ADC sequences are known to be extremely sensitive for the detection of cytotoxic edema and they have been widely used in the assessment of cases with cerebral manifestations. 

In the above case, the diagnosis was confirmed clinically and with laboratory investigations. The MR signal abnormalities completely resolved on the follow up scan soon after the anti-malarial treatment. 

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Case information

rID: 69819
Published: 23rd Jan 2020
Last edited: 12th Mar 2020
Inclusion in quiz mode: Included
Institution: Royal Surrey

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