Revising the Interpretation of Transcranial Doppler Ultrasound Examinations in Pediatric Cerebral Malaria

Abstract

Cerebral malaria (CM) is a devastating disease globally. Transcranial Doppler ultrasound (TCD) has identified five different phenotypes of deranged cerebrovascular hemodynamics in children with CM, each associated with different outcomes. For TCD to be used as a point of care neurodiagnostic and neuromonitoring tool in CM patients, proper interpretation of examinations is paramount. Comparison of measured cerebral blood flow velocities (CBFVs) to age-matched normative values is needed to interpret any pediatric TCD study. Until recently, normative values in African children did not exist, so previous work reported the frequency of CM phenotypes by classifying studies compared with normative values of European children. Now that normative TCD values in healthy African children have been established, we performed this retrospective analysis of prospectively collected data to determine phenotype frequency and associated outcomes in children with CM by comparing CBFV values to these contemporary controls.