Cerebral malaria-using the retina to study the brain.

Beare, Nicholas AV ORCID: 0000-0001-8086-990X (2023) Cerebral malaria-using the retina to study the brain. Eye (London, England), 37 (12). pp. 2379-2384.

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Official URL: http://dx.doi.org/10.1038/s41433-023-02432-z

Abstract

Cerebral malaria (CM) remains a common cause of death of children in Africa with annual mortality of 400 000. Malarial retinopathy is a unique set of fundus signs which has diagnostic and prognostic value in CM. Assessment of malarial retinopathy is now widely utilised in clinical care, and routinely incorporated into clinical studies to refine entry criteria. As a visible part of the central nervous system, the retina provides insights into the pathophysiology of this infectious small-vessel vasculitis with adherent parasitised red blood cells. Fluorescein angiography and optical coherence tomography (OCT) have shown that patchy capillary non-perfusion is common and causes ischaemic changes in the retina in CM. It is likely this is mirrored in the brain and may cause global neurological impairments evident on developmental follow up. Three types of blood-retina barrier breakdown are evident: large focal, punctate, and vessel leak. Punctate and large focal leak (haemorrhage in formation) are associated with severe brain swelling and fatal outcome. Vessel leak and capillary non-perfusion are associated with moderate brain swelling and neurological sequelae. These findings imply that death and neurological sequelae have separate mechanisms and are not a continuum of severity. Each haemorrhage causes a temporary uncontrolled outflow of fluid into the tissue. The rapid accumulation of haemorrhages, as evidenced by multiple focal leaks, is a proposed mechanism of severe brain swelling, and death. Current studies aim to use optic nerve head OCT to identify patients with severe brain swelling, and macula OCT to identify those at risk of neurological sequelae.

Item Type:	Article
Uncontrolled Keywords:	Retinal Vessels, Brain, Retina, Humans, Malaria, Cerebral, Brain Edema, Retinal Diseases, Tomography, Optical Coherence, Fluorescein Angiography, Child
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	02 Mar 2023 11:36
Last Modified:	18 Aug 2023 04:00
DOI:	10.1038/s41433-023-02432-z
Open Access URL:	https://doi.org/10.1038/s41433-023-02432-z
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3168700