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Retinopathy, histidine-rich protein-2 and perfusion pressure in cerebral malaria

Symon M. Kariuki, Charles R. J. C. Newton
DOI: http://dx.doi.org/10.1093/brain/awu144 e298 First published online: 11 June 2014

Sir, We read with interest the detailed review by MacCormick et al. (2014) about the utility of retinopathy in understanding the pathogenesis of paediatric cerebral malaria. The authors conclude that the brain and retina are similar in many ways and may have similar disease processes that are relevant in cerebral malaria; for example, retinal capillary non-perfusion could be a marker for brain ischaemia and swelling often observed in cerebral malaria (Newton et al., 1994). Importantly the authors point out the differences between the retina and brain, particularly arterial-venous ratios and watersheds, and metabolic peaks in childhood, all of which complicate the use of retinopathy in understanding neurovascular diseases, including cerebral malaria.

MacCormick et al. (2014) observe that 25% of the WHO-defined cerebral malaria may be related to other causes of coma other than Plasmodium falciparum malaria, as shown in an autopsy study (Taylor et al., 2004). Recently, histidine-rich …