Investigators from Malawi-Liverpool-Wellcome Trust Research Program, Malawi; University of Liverpool, UK; Michigan State University, USA; Vancouver General Hospital, Canada; and Ophthalmology Centers in Edinburgh, UK, review the evidence for associations between retina and brain neurovasculature, and the extent to which malarial retinopathy reflects cerebrovascular damage. Plasmodium falciparum is the causative organism in the majority of severe malaria cases, particularly in sub-Saharan Africa where children <5 years of age are disproportionately involved. Manifestations of severe pediatric malaria include convulsions, hypoglycemia, hyperparasitemia, coma, and malarial retinopathy. Funduscopic examination reveals white patchy discoloration of the macula, orange discoloration of retinal vessels, retinal hemorrhages with white centers, and papilledema. Associated abnormalities include metabolic acidosis and severe anemia. Duration of illness is short, and most patients either recover or die within 48 hrs. Patients who recover are at risk of neurologic disability and epilepsy.

Sequestration, resulting from binding of parasitized erythrocytes to vascular endothelium, is the hallmark of pediatric cerebral malaria, causing microvascular obstruction in both brain and retina. [1]

COMMENTARY. This review illustrates the value of the funduscopic examination in the clinical diagnosis of neurologic disease. Despite some differences, the retinal pathology of microvasculature mimics the cerebral autopsy findings, and retinopathy is a surrogate marker for pediatric cerebral malaria. Both vascular beds are susceptible to sequestration of parasitized erythrocytes, leading to cerebral vascular obstruction, coma, convulsions, and neuropsychological sequelae.

Cerebral Malaria Retinopathy Predictor of Neurocognitive Outcome

Investigators at Michigan State University, East Lansing; University of Michigan, Ann Arbor; Blantyre Malaria Project, Malawi; and Liverpool University Hospital, UK, studied the relationship of malaria-specific retinopathy during acute cerebral malaria to neurocognitive sequelae in 49 Malawian children tested 1 to 3 years following illness. Scores on Kaufman (mental processing), and TOVA (inattention and impulsivity) were worse in children with retinal hemorrhages, papilledema, optic disc hyperemia, whitening of macula and foveal annulus. Achenbach Child Behavioral Checklist (emotional and behavioral) outcomes were not closely associated with retinopathy severity [2].