Retinal haemorrhage in cerebral malaria.

We examined the fundi of 73 children aged between six months and six years with confirmed diagnosis of cerebral malaria at the Children's Emergency Ward of the University College Hospital, Ibadan. Normal fundi, papilloedema and retinal haemorrhages were present in 38(52.1%), 18(24.7%) and 17(23.3%), respectively on admission. There were no significant differences between the three groups with respect to age, sex, admission coma score, posture, packed cell volume, parasite density, serum glucose, and serum electrolyte profile on admission. The mortality rates were 16%, 22% and 47% in the normal, papilloedema and retinal haemorrhage groups, respectively (Chi-squared for linear trend = 5.587, p = 0.018). Retinal haemorrhage was significantly associated with death (chi 2 = 5.846, p = 0.0192; Crude Odds ratio = 4.1, 95% CI = 1.1, 15.6; p = 0.018). The association was still present after adjusting for other known risk factors for mortality, including age, sex, acidosis, parasite density, anaemia, deep coma, and hypoglycaemia (adjusted Odds Ratio = 4.6, p = 0.0688). Papilloedema alone was not associated with mortality when compared with normal fundi [Fischer's exact (p = 0.448)]. It is concluded that fundoscopic abnormalities are common in children with cerebral malaria, and that retinal haemorrhage is associated with a poor prognosis in such children with cerebral malaria. Therefore, fundoscopic examination is not only useful to rule out raised intracranial pressure before performing a lumbar puncture, but also a useful measure in assessing prognosis in children suffering from cerebral malaria.