Brain swelling and death in children with cerebral malaria.
Brain swelling and death in children with cerebral malaria.
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DOI：
10.1056/nejmoa1400116
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发表时间：
2015-03-19
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影响因子：
--
通讯作者：
Taylor TE
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作者：
Seydel KB;Kampondeni SD;Valim C;Potchen MJ;Milner DA;Muwalo FW;Birbeck GL;Bradley WG;Fox LL;Glover SJ;Hammond CA;Heyderman RS;Chilingulo CA;Molyneux ME;Taylor TE
非洲脑型疟疾儿童的病死率仍在15%至25%之间。主要的发病过程和死亡原因尚不清楚，但临床观察和病理结果表明，脑容量增加导致颅内压升高可能起作用。磁共振成像（MRI）于2009年在马拉维可用，我们用它来研究脑肿胀在非洲儿童致命性脑型疟疾发病机制中的作用。我们招募了符合脑型疟疾严格定义（包括视网膜病变）的儿童，对其进行了详细的临床特征描述，并在入院时和昏迷持续期间每天进行MRI扫描。在348名患有脑型疟疾（根据世界卫生组织的定义）的儿童中，168名符合纳入标准，接受了所有检查，并被纳入分析。共有25名儿童（15%）死亡，其中21名（84%）在入院时MRI显示严重脑肿胀。相比之下，在143名幸存者中有39名（27%）的MRI上观察到严重脑肿胀的证据。连续的核磁共振扫描显示，在最初有脑肿胀的幸存者中，脑体积减少的证据。在死于脑型疟疾的儿童中观察到脑体积增加，但在那些没有死于这种疾病的儿童中并不常见，这一发现表明颅内压升高可能导致致命的结局。自然病程表明颅内压升高在幸存者中是短暂的。（由美国国立卫生研究院和Wellcome Trust U.K.资助）
Case fatality rates among African children with cerebral malaria remain in the range of 15 to 25%. The key pathogenetic processes and causes of death are unknown, but a combination of clinical observations and pathological findings suggests that increased brain volume leading to raised intracranial pressure may play a role. Magnetic resonance imaging (MRI) became available in Malawi in 2009, and we used it to investigate the role of brain swelling in the pathogenesis of fatal cerebral malaria in African children. We enrolled children who met a stringent definition of cerebral malaria (one that included the presence of retinopathy), characterized them in detail clinically, and obtained MRI scans on admission and daily thereafter while coma persisted. Of 348 children admitted with cerebral malaria (as defined by the World Health Organization), 168 met the inclusion criteria, underwent all investigations, and were included in the analysis. A total of 25 children (15%) died, 21 of whom (84%) had evidence of severe brain swelling on MRI at admission. In contrast, evidence of severe brain swelling was seen on MRI in 39 of 143 survivors (27%). Serial MRI scans showed evidence of decreasing brain volume in the survivors who had had brain swelling initially. Increased brain volume was seen in children who died from cerebral malaria but was uncommon in those who did not die from the disease, a finding that suggests that raised intracranial pressure may contribute to a fatal outcome. The natural history indicates that increased intracranial pressure is transient in survivors. (Funded by the National Institutes of Health and Wellcome Trust U.K.)