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In Africa, case fatality rates among children with cerebral malaria (CM) remain high — 15% to 25% — despite effective antimalarial drugs. To determine the pathogenesis of this condition and the risk factors for death from it, investigators studied children aged >5 months who were treated for CM at a single hospital in Malawi between January 2009 and June 2011.
All 168 children had decreased consciousness and ophthalmologist-diagnosed malarial retinopathy. All underwent magnetic resonance imaging (MRI) on admission and ocular funduscopy within 6 hours after admission, and all were treated with intravenous quinine. Mechanical ventilation was not available.
Severely increased brain volume was more likely in the 25 children who died than in the 1…