Magnetic Resonance Imaging Reveals Dysfunction of Blood Brain Barrier in Cerebral Malaria Alone and With Multi Organ Dysfunction Syndrome.

Abstract

Introduction: The underlying mechanism of cerebral malaria alone or with multiple organ dysfunction (MOD) among patients with falciparum malaria is not clearly understood. Though autopsy studies showed various types of pathological changes, during life Magnetic Resonance Imaging (MRI) can identify structural and functional modication of brain during the disease process. There have been few MRI studies of brain among adult patients with cerebral malaria (CM) but none with CM and MOD. Therefore, we have conducted this study to nd out and to compare the MRI abnormalities among patients of CM and CM with MOD. Methods: This prospective study has been conducted at VSSIMSAR, Burla in which 138 consecutive patients of severe falciparum malaria were enrolled. 119 patients after exclusion were subjected to MRI within 10 hours of admission and it was repeated as per the protocol. The diagnosis of P.falciparum malaria was done by peripheral smear or Rapid diagnostic test. The diagnosis of sever malaria was done by WHO criteria. Patients of CM were grouped into Group-1 and of CM with MOD to Group-2. Results: In the study CM and CM with MOD constituted 29 (24.4%) and 90 (75.6%) patients. MRI showed increased brain volume, vasogenic oedema, and cortical thickening in all patients of severe malaria. Cytotoxic oedema also found in 37.9% of cases of CM and 75.5% of MOD (p<0.001). Infarction and haemorrhage were found in less percentage of cases. Predominant posterior swelling consistent with posterior reversible encephalopathy syndrome (PRES) is found in majority of cases of CM (48.3%) compared to frontal swelling (0.0%) (p<0.001). With treatment MRI ndings improved within 72 hours of treatment. Patients who died did not show any improvement in MRI nding. Conclusion: Different type of MRI ndings at different areas of brain is possible in CM and CM with MOD. It is due to dysfunction of blood brain barrier (BBB) and it can be reversible with treatment. Therefore, intervention with drugs improving BBB may be benecial for survival.