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The pathogenesis of cerebral malaria is poorly understood. Direct and indirect ophthalmoscope examinations of 141 Malawian children with strictly defined cerebral malaria revealed 2 distinct and prognostically significant findings: papilloedema and extramacular retinal oedema. The relative risk of death in patients with papilloedema was 6.7 times that in patients without papilloedema. Extramacular retinal oedema was associated with a 2.9 fold increase in the relative risk of dying. The mortality rate in patients with neither of these signs was only 1.3% compared to an overall mortality rate of 9.2%. The clinical and laboratory features associated with each of these ophthalmological findings were different, suggesting that there may be at least 2 different pathogenetic processes in patients with cerebral malaria.

Original publication




Journal article


Trans R Soc Trop Med Hyg

Publication Date





144 - 146


Blood Glucose, Body Temperature, Child, Child, Preschool, Edema, Fundus Oculi, Humans, Infant, Malaria, Cerebral, Papilledema, Predictive Value of Tests, Prognosis, Retinal Diseases, Retinal Hemorrhage, Risk Factors