Blood Vessels in the Brain
Baltimore, MD, United States
Using MRI, white matter abnormalities have been observed in a variety of neurological conditions, including those suffering from cerebral malaria (CM). CM is a serious complication of Plasmodium falciparum infection, and has a profoundly devastating effect especially on children, non-immune travelers and military personnel. Clinically, CM can result in several neurological problems, which include seizures, reversible coma and is associated with a high mortality of up to 30%, with the highest rate in children. Acute neurological symptoms include impaired consciousness, coma, delirium, seizures, and increased intracranial hypertension. In African children, and adult non-immune travelers, persistent neurologic deficits may occur after surviving CM episodes. The hallmark of CM pathology is the intra-vascular sequestration of parasitized red blood cells (PRBC) inside high endothelial venules throughout the brain. PRBC bind to the blood brain barrier (BBB) endothelium in both white and gray matter but do not invade into the brain. Interestingly, the PRBC sequestration in blood vessels leads to a distinctly different pathology between white and gray matter. Recent postmortem studies reveal a clear hemorrhagic pathology within the white matter. Our previous data showed highly inflammatory responses associated with gray matter endothelium. Yet, little is known of the factors that cause these differences of the brain endothelium residing in gray versus white matter and how any potential differences could relate to divergent responses in CM.
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