Brain Swelling and Mannitol Therapy in Adult Cerebral Malaria: A Randomized Trial

Abstract

Mild cerebral swelling on CT-scan was common in adult patients with cerebral malaria, but severity of swelling was not correlated with coma depth or survival. Mannitol as adjunctive treatment for cerebral malaria prolonged coma duration and may be harmful.

Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria

“…This age-related difference in brain swelling during acute CM may relate to the more loosely organized extracellular spaces in children, which occupy about 20% of total brain volume and enable a more rapid development of brain swelling compared to adults [ 21 ], as described in other diseases [ 22 , 23 ]. In adult patients with CM, our findings confirm the lack of association between mortality and brain swelling [ 9 , 12 ].…”

Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria

“…This age-related difference in brain swelling during acute CM may relate to the more loosely organized extracellular spaces in children, which occupy about 20% of total brain volume and enable a more rapid development of brain swelling compared to adults [ 21 ], as described in other diseases [ 22 , 23 ]. In adult patients with CM, our findings confirm the lack of association between mortality and brain swelling [ 9 , 12 ].…”

Magnetic resonance imaging during life: the key to unlock cerebral malaria pathogenesis?

“…Further research into the integrity of this permeability barrier as a source for non-enhancement is presently being undertaken using contrast in paediatric CM patients on the high field MRI located in neighbouring Zambia. However, the results generated are in line with previous reports in adult CM MRIs [ 58 ] and CT scans in both paediatric [ 50 ] and adult patients [ 51 , 52 ], suggesting that increased brain volume may be a common feature in CM, and that it may be implicated in the pathogenesis of death in patients with CM. This could also explain its reversibility, as brain swelling decreases significantly during recovery (Figure 3 ).…”

Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the Anesthesia-Resuscitation Department CHU Ignace Deen

“…This same observation was made by Mohanty et al [22] Severe malaria is a diagnostic and therapeutic emergency. Anti-infective treatment must therefore be initiated immediately (at the latest within two hours).…”

Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria

“…This age-related difference in brain swelling during acute CM may relate to the more loosely organized extracellular spaces in children, which occupy about 20% of total brain volume and enable a more rapid development of brain swelling compared to adults [ 21 ], as described in other diseases [ 22 , 23 ]. In adult patients with CM, our findings confirm the lack of association between mortality and brain swelling [ 9 , 12 ].…”

Magnetic resonance imaging during life: the key to unlock cerebral malaria pathogenesis?

“…Further research into the integrity of this permeability barrier as a source for non-enhancement is presently being undertaken using contrast in paediatric CM patients on the high field MRI located in neighbouring Zambia. However, the results generated are in line with previous reports in adult CM MRIs [ 58 ] and CT scans in both paediatric [ 50 ] and adult patients [ 51 , 52 ], suggesting that increased brain volume may be a common feature in CM, and that it may be implicated in the pathogenesis of death in patients with CM. This could also explain its reversibility, as brain swelling decreases significantly during recovery (Figure 3 ).…”

Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the Anesthesia-Resuscitation Department CHU Ignace Deen

“…This same observation was made by Mohanty et al [22] Severe malaria is a diagnostic and therapeutic emergency. Anti-infective treatment must therefore be initiated immediately (at the latest within two hours).…”

Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria

“…This age-related difference in brain swelling during acute CM may relate to the more loosely organized extracellular spaces in children, which occupy about 20% of total brain volume and enable a more rapid development of brain swelling compared to adults [ 21 ], as described in other diseases [ 22 , 23 ]. In adult patients with CM, our findings confirm the lack of association between mortality and brain swelling [ 9 , 12 ].…”

Magnetic resonance imaging during life: the key to unlock cerebral malaria pathogenesis?

“…Further research into the integrity of this permeability barrier as a source for non-enhancement is presently being undertaken using contrast in paediatric CM patients on the high field MRI located in neighbouring Zambia. However, the results generated are in line with previous reports in adult CM MRIs [ 58 ] and CT scans in both paediatric [ 50 ] and adult patients [ 51 , 52 ], suggesting that increased brain volume may be a common feature in CM, and that it may be implicated in the pathogenesis of death in patients with CM. This could also explain its reversibility, as brain swelling decreases significantly during recovery (Figure 3 ).…”

Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the Anesthesia-Resuscitation Department CHU Ignace Deen

“…This same observation was made by Mohanty et al [22] Severe malaria is a diagnostic and therapeutic emergency. Anti-infective treatment must therefore be initiated immediately (at the latest within two hours).…”