Adult Cerebral Malaria: Prognostic Importance of Imaging Findings and Correlation with Postmortem Findings

PURPOSE: To correlate imaging abnormalities, clinical features, and postmortem findings in patients with proved cerebral malaria. MATERIALS AND METHODS: Twenty-one patients aged 17–50 years with cerebral malaria consented to undergo transverse nonenhanced (10-mm sections) and contrast material–enhanced (8-mm sections in posterior fossa and 10-mm sections in supratentorial region) CT on admission (n = 21) and on day 10 (n = 6), with thin sections (5 mm) obtained in the area of abnormality. All CT scans were evaluated for diffuse cerebral edema, focal parenchymal abnormalities, and hemorrhage. CT findings were categorized as normal, diffuse cerebral edema, and edema with thalamic hypoattenuation without or with cerebellar hypoattenuation. Spearman rank correlation test was performed. RESULTS: Initial scans were normal in seven patients with mild disease (median Acute Physiology and Chronic Health Evaluation [APACHE] II score of 7, median Glasgow Coma Scale [GCS] score of 10), and all survived. Of eight pati...