Intracranial pressure in African children with cerebral malaria

Newton, Charles R.; Kirkham, Fenella J.; Winstanley, PA; Pasvol, Geoffrey; Peshu, Norbert; Warrell, D A; Marsh, Kevin

doi:10.1016/0140-6736(91)91638-b

Cited by 187 publications

(127 citation statements)

References 16 publications

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“…Secondary endpoints included in-hospital mortality, resolution of acidosis (percentage reduction of base deficit by 8 hours), potential complications of volume resuscitation (pulmonary oedema, raised intracranial pressure (systolic blood pressure of >90 th centile for age in association with a falling heart rate, or papilloedema, or brain stem features of transtentorial herniation [22])), allergic reaction, and neurological sequelae determined at discharge and one month following discharge by standardised neurological assessment.…”

Section: Discussionmentioning

confidence: 99%

Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria*

Akech

Jemutai

Timbwa

et al. 2010

Critical Care Medicine

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Objective: A previous meta-analysis has shown a consistent survival benefit in children with severe malaria receiving human albumin solution (HAS) compared to other resuscitation fluids.HAS is expensive and not readily available in Africa. We examined the safety and efficacy of the fluid resuscitation with two synthetic colloids, Dextran 70 and hydroxyethyl starch to inform future trial design.Design: An open-label randomised controlled, phase II safety and efficacy trial. 23/37 (62%) and 25/39 (64%) respectively (p=0.99). Acidosis resolution and respiratory distress was marginally superior in HES group: 3/39 (8%) remained acidotic at 8 hours versus 10/37 (27%) in Dextran arm (p=0.05). There were 4 deaths (5%), two per arm; including 3 deaths in the coma subgroup (3/39, 8%). No other new adverse event was reported. Conclusions:Correction of shock by volume expansion with either Dextran or HES in children with severe malaria acidosis is safe with low mortality, including the highest risk cases admitted in coma. Both solutions present an attractive and practical option for consideration in future volume resuscitation trials in severe malaria.3

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Section: Discussionmentioning

confidence: 99%

Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria*

Akech

Jemutai

Timbwa

et al. 2010

Critical Care Medicine

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“…Warrell et al (1986) found that over 80% of the opening lumbar puncture pressures in the Thai adults with CM were within the normal range. However, ICP are raised in almost all African children with CM (Newton et al 1991;Waller et al 1991;Lewallen et al 1996), although the pressures are often lower than those measured in adults. Raised ICP can be caused by an increase in the CSF compartment (hydrocephalus), cerebral oedema or an increased blood volume.…”

Section: Studies Of the Functional Integritymentioning

confidence: 99%

“…Magnetic resonance imaging studies, which are even more sensitive, found little evidence of cerebral oedema in Thai adults (Looareesuwan et al 1995), but did find brain swelling. It is likely that increased cerebral blood volume (Newton et al 1991), from the sequestered mass and/or increased cerebral blood flow (Newton et al 1996) is responsible for the raised ICP in children. However, a breakdown of the BBB may aggravate the intracranial hypertension, and precipitate death.…”

Section: Studies Of the Functional Integritymentioning

confidence: 99%

“…CM is rarely encountered after the age of 10 years in people exposed to P. falciparum since birth. Children with CM often present with a history of seizures and many die with brainstem signs suggestive of transtentorial herniation (Newton et al 1991). Mortality ranges from 15 to 30% and 11% of children have neurological deficits on discharge (Newton & Krishna 1998).…”

Section: Neurological Complications Of Falciparum Malariamentioning

confidence: 99%

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Review Article: Blood-brain barrier in falciparum malaria*

Gitau

Newton

2005

Trop Med Int Health

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SummaryPlasmodium falciparum malaria is the most important parasitic disease infecting the central nervous system of humans worldwide. The pathogenesis of the neurological complications of falciparum malaria remains unclear. In particular, how do asexual parasites confined to the vascular space of the brain cause neuronal impairment? The evidence for a breakdown in the blood-brain barrier (BBB) is conflicting. In some animal models of malaria, there is evidence of breakdown of the BBB, but the data from humans suggests the BBB is mildly impaired only, with few morphological changes. Whether these changes in the BBB are sufficient to account for the neurological complications remains to be determined.keywords falciparum malaria, blood-brain barrier impairment

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“…Intracranial pressure, inferred from CSF opening pressure, was measured in a population of children with CM and found to be universally raised [29]. A subsequent study directly measuring intracranial pressure in 23 children with CM found all subjects had increased pressures, with mortality correlating with degree of intracranial hypertension.…”

Section: Pathogenesismentioning

confidence: 99%

Pediatric Cerebral Malaria: A Scourge of Africa

et al. 2012

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Cerebral malaria, defined as an otherwise unexplained coma in a patient with Plasmodium falciparum parasitemia, affects up to 1 million people per year, the vast majority of them being children living in sub-Saharan Africa. Despite optimal treatment, this condition kills 15% of those affected and leaves 30% of survivors with neurologic sequelae. The clinical diagnosis is hampered by its poor specificity, but the presence or absence of a malarial retinopathy in cerebral malaria has proven to be important in the differentiation of underlying coma etiology. Both antimalarials and intense supportive care are necessary for optimal treatment. As of yet, clinical trials of adjunctive therapies have not improved the high rates of mortality and morbidity. Survivors are at high risk of neurologic sequelae including epilepsy, neurodisabilities and cognitive–behavioral problems. The neuroanatomic and functional bases of these sequelae are being elucidated. Although adjunctive therapy trials continue, the best hope for African children may lie in disease prevention. Strategies include bednets, chemoprophylaxis and vaccine development.

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Intracranial pressure in African children with cerebral malaria

Cited by 187 publications

References 16 publications

Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria*

Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria*

Review Article: Blood-brain barrier in falciparum malaria*

Pediatric Cerebral Malaria: A Scourge of Africa

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