Brain Swelling Associated with Mortality in Cerebral Malaria

Brain swelling, a symptom of cerebral malaria, is a significant predictor of which children will die of the disease, an article in the New England Journal of Medicine (NEJM) indicated.

With a 15-25% mortality rate, the exact cause of death from cerebral malaria isn’t understood. However, the study’s authors referred to previous research, which claimed that an increase in brain’s weight — causing intracranial pressure — plays a role.

For their study, Michigan State University’s (MSU) Terrie Taylor and her colleagues admitted 168 children with cerebral malaria and administered an MRI, which became available to Malawians in 2009. The team — who conducted an MRI daily — then compared the scans of children who died versus survivors of the disease.

From the MRI scans, the investigators discovered of the 25 (15%) children who subsequently died, 21 (84%) experienced significant brain swelling. In comparison, only 39 (27%) of 143 survivors had this symptom.

“Serial MRI scans showed evidence of decreasing brain volume in the survivors who had had brain swelling initially,” the authors also noted.

Specifically, Taylor and their team documented in cerebral malaria mortalities, the brain becomes so enlarged it comes out of the skull and puts pressure on the brain stem — causing the patient to stop breathing.

“We discovered that some children with cerebral malaria develop massively swollen brains and those are the children who die,” Taylor said.

Taylor also commented that this study provided more insight into treatments that could counteract the disease.

“The next step is to identify what’s causing the swelling and then develop treatments targeting those causes,” she offered. “It’s also possible that using ventilators to keep the children breathing until the swelling subsides might save lives, but ventilators are few and far between in Africa at the moment.”