Affiliations: St Paul's Eye Unit, Royal Liverpool University
Hospital, Liverpool, UK | Kenya Medical Research Institute (KEMRI), Kilifi
District Hospital, Kilifi, Kenya | Neurosciences Unit, Institute of Child Health,
University College London, London, UK | Ophthalmology Research Unit, School of Clinical
Sciences, University of Liverpool, Liverpool, UK
Abstract: Raised intracranial pressure is a feature of cerebral malaria in
children living in Africa. We investigated specific clinical optic disc
features of papilledema to establish their prognostic significance in this
encephalopathy. We developed a classification of acute papilledema and tested
it against disease outcome. Kenyan children admitted with severe falciparum
malaria (cerebral or impaired consciousness) underwent dilated fundal
examination using direct and indirect ophthalmoscopy. Clinical features of the
optic disc were systematically recorded and compared to the child's outcome.
Poor outcome defined as death or neurological impairment on discharge was used
to construct and test a clinical classification of papilledema. Forty-five
children were examined (26 cerebral malaria, 17 severe malaria with an impaired
conscious level or prostration) of whom seven had a poor outcome (three died,
four had residual neurological impairment). Loss of the optic disc cup and
marked optic disc elevation were significantly correlated with a poor outcome
(P<0.05). Increasing severity in the proposed classification
of acute papilledema was positively correlated with a poor outcome
(P<0.05, chi-square test for trend). Loss of the optic disc
cup and marked elevation of the optic disc head appear to be correlated with
poor outcome in children with severe malaria whereas the presence of dilated
veins suggests a good outcome. The proposed classification of acute papilledema
is useful as a prognostic indicator and may be applicable to other
encephalopathies with raised intracranial pressure.
