Brain magnetic resonance imaging in imported malaria

Malar J. 2019 Mar 12;18(1):74. doi: 10.1186/s12936-019-2713-2.

Abstract

Background: Previous studies have documented a spectrum of brain magnetic resonance imaging (MRI) abnormalities in patients with cerebral malaria, but little is known about the prevalence of such abnormalities in patients with non-cerebral malaria. The aim of this study was to assess the frequency of brain MRI findings in returning travellers with non-cerebral malaria.

Methods: A total of 17 inpatients with microscopically confirmed Plasmodium falciparum non-cerebral malaria underwent structural brain MRI at 3.0 Tesla, including susceptibility-weighted imaging (SWI). Presence of imaging findings was recorded and correlated with clinical findings and parasitaemia.

Results: Structural brain abnormalities included a hyperintense lesion of the splenium on T2-weighted imaging (n = 3) accompanied by visible diffusion restriction (n = 2). Isolated brain microhaemorrhage was detected in 3 patients. T2-hyperintense signal abnormalities of the white matter ranged from absent to diffuse (n = 10 had 0-5 lesions, n = 5 had 5-20 lesions and 2 patients had more than 50 lesions). Imaging findings were not associated with parasitaemia or HRP2 levels.

Conclusion: Brain MRI reveals a considerable frequency of T2-hyperintense splenial lesions in returning travellers with non-cerebral malaria, which appears to be independent of parasitaemia.

Keywords: Cerebral malaria; Complicated malaria; Imported malaria; MRI; Malaria; P. falciparum; Splenial lesion; Splenium; Uncomplicated malaria.

MeSH terms

  • Adult
  • Brain Diseases / diagnostic imaging*
  • Brain Diseases / epidemiology
  • Brain Diseases / pathology*
  • Cohort Studies
  • Communicable Diseases, Imported / pathology*
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Malaria, Falciparum / pathology*
  • Male
  • Middle Aged
  • Prevalence
  • Young Adult