Mild cerebral swelling on CT-scan was common in adult patients with cerebral malaria, but severity of swelling was not correlated with coma depth or survival. Mannitol as adjunctive treatment for cerebral malaria prolonged coma duration and may be harmful.

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Plasma lipid peroxides were measured as malonyldialdehyde (MDA) by the thiobarbituric acid (TBA) method in 75 children suffering from Plasmodium falciparum malaria. Their riboflavin status was assessed by measuring erythrocyte glutathione reductase activation coefficients (EGRACs), and values greater than 1.40 were regarded as indicating biochemical deficiency. Plasma MDA was higher (p less than 0.001) in patients than in control subjects; the concentrations were 3.65 +/- 0.70 and 1.77 +/- 0.45 mumol/L (means +/- SD), respectively. The riboflavin-deficient group had higher plasma MDA values (3.98 +/- 0.70 mumol/L) than did the nondeficient group (3.30 +/- 0.68 mumol/L, p less than 0.001). Plasma MDA concentrations correlated with EGRACs (r = 0.46, p less than 0.01) in the patients. It is proposed that riboflavin deficiency restricts regeneration of reduced glutathione making the parasitized erythrocytes more vulnerable to destructive lipid peroxidation and increasing plasma lipid hydroperoxides.

Membrane lipid peroxidation by reactive oxygen species leading to increased capillary permeability is considered an important event in the pathogenesis of severe malaria. A significant decrease in plasma albumin and increases in cerebrospinal fluid (CSF) protein and malondialdehyde (MDA) were observed in 73 patients with cerebral malaria, compared to values in 23 control patients. The greatest effect was noticed in the most severely ill patients. The ratio of CSF protein to plasma albumin was increased in the patients compared to the controls, and in fatal cases of cerebral malaria compared to non-fatal cases. Brain necropsies showed oedema, fibrin deposits and mononuclear cell infiltration. It is proposed that cerebral oedema due to enhanced permeability of vascular endothelium induced by increased lipid peroxidation plays a crucial role in the causation of cerebral malaria.