Yadav P, Sharma R, Kumar S, Kumar U
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Acta Radiol. 2008 Jun;49(5):566-9. doi: 10.1080/02841850802020476.
Cerebral malaria is a major health hazard, with a high incidence of mortality. The disease is endemic in many developing countries, but with a greater increase in tourism, occasional cases may be detected in countries where the disease in not prevalent. Early diagnosis and evaluation of cerebral involvement in malaria utilizing modern imaging modalities have an impact on the treatment and clinical outcome.
To evaluate the magnetic resonance (MR) features of patients with cerebral malaria presenting with altered sensorium.
We present the findings in three patients with cerebral malaria presenting with altered sensorium. MR imaging using a 1.5-Tesla unit was carried out. The sequences performed were 5-mm-thick T1-weighted, T2-weighted, fluid-attenuated inversion-recovery (FLAIR), and T2-weighted gradient-echo axial sequences, and sagittal and coronal FLAIR. Diffusion-weighted imaging was performed with b values of 0 and 1000 s/mm(2), and apparent diffusion coefficient (ADC) maps were obtained.
Focal hyperintensities in the bilateral periventricular white matter, corpus callosum, occipital subcortex, and bilateral thalami were noticed on T2-weighted and FLAIR sequences. The lesions were more marked in the splenium of the corpus callosum. No enhancement on postcontrast T1-weighted MR images was observed. There was no evidence of restricted diffusion on the diffusion-weighted sequence and ADC map.
MR is a sensitive imaging modality, with a role in the assessment of cerebral lesions in malaria. Focal white matter and corpus callosal lesions without any restricted diffusion were the key findings in our patients.
脑型疟疾是一种主要的健康危害，死亡率很高。该疾病在许多发展中国家呈地方性流行，但随着旅游业的大幅增长，在非流行国家偶尔也会发现病例。利用现代成像方式对疟疾患者的脑部受累情况进行早期诊断和评估，对治疗及临床结果有影响。
评估出现意识改变的脑型疟疾患者的磁共振（MR）特征。
我们展示了3例出现意识改变的脑型疟疾患者的检查结果。使用1.5特斯拉设备进行了MR成像。所采用的序列包括5毫米厚的T1加权、T2加权、液体衰减反转恢复（FLAIR）以及T2加权梯度回波轴位序列，还有矢状位和冠状位FLAIR序列。使用b值为0和1000 s/mm²进行扩散加权成像，并获得表观扩散系数（ADC）图。
在T2加权和FLAIR序列上，双侧脑室周围白质、胼胝体、枕叶皮质下以及双侧丘脑出现局灶性高信号。病变在胼胝体压部更为明显。增强后的T1加权MR图像上未观察到强化。在扩散加权序列和ADC图上没有扩散受限的证据。
MR是一种敏感的成像方式，在评估疟疾脑部病变中具有作用。局灶性白质和胼胝体病变且无任何扩散受限是我们患者的关键发现。
