Transient lesion in the splenium of the corpus callosum in acute uncomplicated falciparum malaria

Patients with acute uncomplicated Plasmodium falciparum malaria have no evident neurologic disorder, vital organ dysfunction, or other severe manifestations of infection. Nonetheless, parasitized erythrocytes cytoadhere to the endothelium throughout their microvasculature, especially within the brai...

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Bibliographic Details
Published in:The American journal of tropical medicine and hygiene 2014-06, Vol.90 (6), p.1117-1123
Main Authors: Laothamatas, Jiraporn, Sammet, Christina L, Golay, Xavier, Van Cauteren, Marc, Lekprasert, Varinee, Tangpukdee, Noppadon, Krudsood, Srivicha, Leowattana, Wattana, Wilairatana, Polrat, Swaminathan, Srirama V, DeLaPaz, Robert L, Brown, Truman R, Looareesuwan, Sornchai, Brittenham, Gary M
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Antimalarials - administration & dosage
Artemisinins - administration & dosage
Chloroquine - administration & dosage
Corpus Callosum - parasitology
Corpus Callosum - pathology
Drug Therapy, Combination
Follow-Up Studies
Hemolysis
Humans
Magnetic Resonance Imaging
Malaria, Falciparum - diagnostic imaging
Malaria, Falciparum - drug therapy
Malaria, Falciparum - pathology
Male
Middle Aged
Parasitemia
Plasmodium falciparum
Primaquine - administration & dosage
Prospective Studies
Radiography
Thailand
Thrombocytopenia
Young Adult
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Summary:Patients with acute uncomplicated Plasmodium falciparum malaria have no evident neurologic disorder, vital organ dysfunction, or other severe manifestations of infection. Nonetheless, parasitized erythrocytes cytoadhere to the endothelium throughout their microvasculature, especially within the brain. We aimed to determine if 3 Tesla magnetic resonance imaging studies could detect evidence of cerebral abnormalities in these patients. Within 24 hours of admission, initial magnetic resonance imaging examinations found a lesion with restricted water diffusion in the mid-portion of the splenium of the corpus callosum of 4 (40%) of 10 male patients. The four patients who had a splenial lesion initially had evidence of more severe hemolysis and thrombocytopenia than the six patients who had no apparent abnormality. Repeat studies four weeks later found no residua of the lesions and resolution of the hematologic differences. These observations provide evidence for acute cerebral injury in the absence of severe or cerebral malaria.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.13-0665