A 10-y-old boy presented with history of on and off fever with rigor for one week followed by altered sensorium. Brain magnetic resonance imaging (MRI) revealed abnormal areas of hyperintensities on T2-weighted images involving bilateral thalami, bilateral external capsule, midbrain, pons, cerebellar peduncles, and splenium.
Cerebral malaria is a common presentation of severe Plasmodium falciparum infection and remains an important cause of death in the tropics. Key aspects of its pathogenesis are still incompletely understood, but severe brain swelling identified by magnetic resonance imaging (MRI) was associated with a fatal outcome in African children. In contrast, neuroimaging investigations failed to identify cerebral features associated with fatality in Asian adults.