Retinopathy in cerebral malaria

Cerebral malaria is one of the most common neurologic diseases in the world. According to WHO estimates, in 2010 alone there were over 216 million cases of malaria, and over 650,000 deaths, with 90% of deaths occurring in children.¹ Among survivors of cerebral malaria, neurologic sequelae are common, with almost a third of patients developing epilepsy or other neurodevelopmental disabilities.² Despite this, we know surprisingly little about the pathophysiology of cerebral malaria. Presumably sequestration of the parasite in the central circulation, with parasitized red blood cells interrupting normal cerebral blood flow, plays an important role. However, recent evidence suggests that the pathophysiology may be modulated by downstream effectors including nitric oxide, immune activation, excitotoxicity, and disruption of the blood–brain barrier leading to increased intracranial pressure.³ Complicating any discussion of pathophysiology, however, is the difficulty in describing exactly what we mean when we talk about cerebral malaria.

Cerebral malaria is defined by the …