Of all malarial complications, cerebral malaria is the deadliest.
Mainly affecting children, who can die after going into coma, its lethality has largely been a mystery — until now.
Cerebral malaria patients are known to die because they stop breathing, and the disease is marked by significant swelling in the brain.
According to Dr. Terrie E. Taylor of Michigan State University, most researchers thought the swollen brain pushed on the bottom of the skull, compressing the brain stem.
“And that’s where the respiratory center is," she said. "So once that respiratory center is pressed upon, the actual neural impulse to take a breath is quashed.”
But an extensive autopsy study of cerebral malaria victims was inconclusive.
“We didn’t see the kind of classic ‘textbook features’ that we were expecting to see.”
Instead of looking at brains in an autopsy, Taylor thought the answer might be found in MRI brain scans of living patients. But Malawi, where Taylor spends about half of each year, did not have an MRI scanner.
So in 2008, General Electric donated an MRI machine to Queen Elizabeth Hospital in Blantyre. Taylor says that allowed her team to monitor patients and also compare those who survived with those who did not.
“Nearly all those who died all had increased brain swelling, and the survivors had a much smaller incidence of brain swelling,” she said.
With the discovery of how cerebral malaria victims die, Taylor says the next step is to try to find out what is causing the brain to swell, so perhaps it can be reversed.
At the same time, she wants to see if putting patients on a ventilator to support their breathing for a few days might allow them to survive until the brain swelling subsides.
Taylor’s paper on how children with cerebral malaria die is published in The New England Journal of Medicine.