Arch Dis Child 1997;76:219-226 ( March )

Intracranial hypertension in Africans with cerebral malaria

C R J C Newton,^a J Crawley,^b A Sowumni,^c C Waruiru,^d I Mwangi,^d M English,^b S Murphy,^e P A Winstanley,^e K Marsh,^b F J Kirkham^f

^a Kenya Medical Research Institute, Clinical Research Centre, Kilifi, Kenya and Department of Paediatrics, University of Oxford, ^b Kenya Medical Research Institute, Clinical Research Centre, Kilifi, Kenya and Nuffield Department of Clinical Medicine, University of Oxford, ^c Kenya Medical Research Institute, Clinical Research Centre, Kilifi, Kenya and Department of Pharmacology and Therapeutics, University of Ibadan, Nigeria, ^d Kenya Medical Research Institute, Clinical Research Centre, Kilifi, Kenya, ^e Kenya Medical Research Institute, Clinical Research Centre, Kilifi, Kenya and Department of Pharmacology and Therapeutics, University of Liverpool, ^f Neurosciences Unit, Institute of Child Health, University College London, London

Correspondence to: Dr C R J C Newton, Neurosciences Unit, The Wolfson Centre, Mecklenburgh Square, London WC1N 2AP.

Accepted 2 October 1996

The causes of death and neurological sequelae in African children with cerebral malaria are obscure. Intracranial pressure (ICP) was monitored and cerebral perfusion pressure (CPP) calculated in 23 Kenyan children with cerebral malaria. Four children had severe intracranial hypertension (ICP >40 mm Hg, CPP <40 mm Hg): two died, one with an ICP of 158 mm Hg and signs of transtentorial herniation, the other one with an ICP of 42 mm Hg and cardiorespiratory arrest. The other two survived with severe neurological sequelae. Nine had intermediate intracranial hypertension (ICP >20 mm Hg, CPP <50 mm Hg) and 10 had mild intracranial hypertension (maximum ICP 10-20 mm Hg); all survived without severe sequelae. Mannitol controlled the ICP in children with intermediate intracranial hypertension, but it did not prevent the development of intractable intracranial hypertension in children with severe intracranial hypertension. Intracranial hypertension is a feature of Kenyan children with cerebral malaria and severe intracranial hypertension is associated with a poor outcome.

Keywords: cerebral malaria; intracranial pressure.

---

© 1997 by Archives of Disease in Childhood
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Day, N., Dondorp, A. M. (2007). The Management of Patients with Severe Malaria. Am J Trop Med Hyg 77: 29-35 [Abstract] [Full Text]  
• Solomon, T., Hart, I. J, Beeching, N. J (2007). Viral encephalitis: a clinician's guide. PN 7: 288-305 [Abstract] [Full Text]  
• Kokwaro, G. O., Muchohi, S. N., Ogutu, B. R., Newton, C. R. J. C. (2006). Chloramphenicol Pharmacokinetics in African Children with Severe Malaria. J Trop Pediatr 52: 239-243 [Abstract] [Full Text]  
• Whitty, C. J M, Lalloo, D., Ustianowski, A. (2006). Malaria: an update on treatment of adults in non-endemic countries. BMJ 333: 241-245 [Full Text]  
• Pasvol, G. (2006). The treatment of complicated and severe malaria. Br Med Bull 75-76: 29-47 [Abstract] [Full Text]  
• Ho, M., Hoang, H. L., Lee, K. M., Liu, N., MacRae, T., Montes, L., Flatt, C. L., Yipp, B. G., Berger, B. J., Looareesuwan, S., Robbins, S. M. (2005). Ectophosphorylation of CD36 Regulates Cytoadherence of Plasmodium falciparum to Microvascular Endothelium under Flow Conditions. Infect. Immun. 73: 8179-8187 [Abstract] [Full Text]  
• Penet, M.-F., Viola, A., Confort-Gouny, S., Le Fur, Y., Duhamel, G., Kober, F., Ibarrola, D., Izquierdo, M., Coltel, N., Gharib, B., Grau, G. E., Cozzone, P. J. (2005). Imaging Experimental Cerebral Malaria In Vivo: Significant Role of Ischemic Brain Edema. J. Neurosci. 25: 7352-7358 [Abstract] [Full Text]  
• Maitland, K., Nadel, S., Pollard, A. J, Williams, T. N, Newton, C. R J C, Levin, M. (2005). Management of severe malaria in children: proposed guidelines for the United Kingdom. BMJ 331: 337-343 [Full Text]  
• Tomlinson, R. J, Morrice, J. (2003). Does intravenous mannitol improve outcome in cerebral malaria?. Arch. Dis. Child. 88: 640-641 [Full Text]  
• Maitland, K., Levin, M., English, M., Mithwani, S., Peshu, N., Marsh, K., Newton, C.R.J.C. (2003). Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia. QJM 96: 427-434 [Abstract] [Full Text]  
• Solomon, T., Dung, N. M., Kneen, R., Thao, L. T. T., Gainsborough, M., Nisalak, A., Day, N. P. J., Kirkham, F. J., Vaughn, D. W., Smith, S., White, N. J. (2002). Seizures and raised intracranial pressure in Vietnamese patients with Japanese encephalitis. Brain 125: 1084-1093 [Abstract] [Full Text]  
• Weatherall, D. J., Miller, L. H., Baruch, D. I., Marsh, K., Doumbo, O. K., Casals-Pascual, C., Roberts, D. J. (2002). Malaria and the Red Cell. ASH Education Book 2002: 35-57 [Abstract] [Full Text]  
• Chang, W.-L., Jones, S. P., Lefer, D. J., Welbourne, T., Sun, G., Yin, L., Suzuki, H., Huang, J., Granger, D. N., van der Heyde, H. C. (2001). CD8+-T-Cell Depletion Ameliorates Circulatory Shock in Plasmodium berghei-Infected Mice. Infect. Immun. 69: 7341-7348 [Abstract] [Full Text]  
• Kirkham, F J (2001). Non-traumatic coma in children. Arch. Dis. Child. 85: 303-312 [Full Text]  
• Sanni, L. A., Rae, C., Maitland, A., Stocker, R., Hunt, N. H. (2001). Is Ischemia Involved in the Pathogenesis of Murine Cerebral Malaria?. Am. J. Pathol. 159: 1105-1112 [Abstract] [Full Text]  
• Crawley, J, Smith, S, Muthinji, P, Marsh, K, Kirkham, F (2001). Electroencephalographic and clinical features of cerebral malaria. Arch. Dis. Child. 84: 247-253 [Abstract] [Full Text]  
• Newton, C. R J C, Hien, T. T., White, N. (2000). NEUROLOGICAL ASPECTS OF TROPICAL DISEASE: Cerebral malaria. J. Neurol. Neurosurg. Psychiatry 69: 433-441 [Abstract] [Full Text]