Looareesuwan S, Wilairatana P, Krishna S, Kendall B, Vannaphan S, Viravan C, White N J
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Clin Infect Dis. 1995 Aug;21(2):300-9. doi: 10.1093/clinids/21.2.300.
In a prospective study of cerebral malaria, 24 adults with this disease underwent magnetic resonance imaging (MRI) of the brain. Four patients died. Two of these patients (nos. 17 and 24) had breathing abnormalities requiring ventilatory support followed by clinical signs of brain death. Four days later MRI of patient 17 showed gross swelling of the brain, and 5 hours later MRI of patient 24 showed foramen magnum herniation. Twenty-two patients had no evidence of cerebral edema, but MRI revealed that brain volume during acute cerebral malaria was slightly greater than that during the convalescent phase of the disease. This difference was attributed to an increase in the volume of intracerebral blood. The cerebral volume was lower during early convalescence than several months later. The volume of the brain in patients with cerebral malaria is increased. This increased volume probably results from sequestration of parasitized erythrocytes and compensatory vasodilatation rather than from edema. Brain stem herniation may occur, but its temporal relation to brain death in cases of cerebral malaria remains uncertain.
在一项关于脑型疟疾的前瞻性研究中，24名患有该病的成年人接受了脑部磁共振成像（MRI）检查。4名患者死亡。其中2名患者（第17号和第24号）出现呼吸异常，需要通气支持，随后出现脑死亡的临床体征。4天后，第17号患者的MRI显示脑部明显肿胀，5小时后，第24号患者的MRI显示枕骨大孔疝。22名患者没有脑水肿的证据，但MRI显示，急性脑型疟疾期间的脑容量略大于疾病恢复期的脑容量。这种差异归因于脑内血量的增加。早期恢复期的脑容量低于数月后的脑容量。脑型疟疾患者的脑容量增加。这种增加的容量可能是由于被寄生红细胞的滞留和代偿性血管扩张，而不是由于水肿。可能会发生脑干疝，但在脑型疟疾病例中，其与脑死亡的时间关系仍不确定。
