Table 4 Long-term mental health disorders and brain MRI findings in children with cerebral malaria
ID | Exposure | Gender female/male | Age on exposure, years | Parents concerns | Specific mental health disorder on DSM-IV criteria | Brain MRI findings |
|---|---|---|---|---|---|---|
1 | Cerebral malaria | Male | 1.9 | Episodic aggressive behaviour, wets his bed, restless and inattentive | ADHD (inattentive type) also has anxiety and depressive symptoms | Brain MRI not done |
2 | Cerebral malaria | Female | 2.2 | Extremely quiet; plays alone and destroys property; bed wetting | Major depression (current) | Normal brain MRI |
3 | Cerebral malaria | Female | 5.7 | Running away from home, often leaves the classroom and moves around | Conduct disorder | Brain MRI not done |
4 | Cerebral malaria | Male | 5.8 | Aggressive behaviour, inattentive, excessive talking, conduct problems | ADHD (inattentive type) conduct disorder | Bilateral punctuate (but few) white matter, high T2 signal foci measuring 1.5–2.0 mm in the parietal regions regions of the cerebral hemispheres close to the vertex. No restriction of water diffusion (on DWI) |
5 | Cerebral malaria | Male | 3.0 | Shy, low self esteem | Social phobia (social anxiety disorder) | Normal brain MRI |
6 | Cerebral malaria | Male | 4.0 | Fighting, aggressive behaviour, anger, lies, poor concentration at school and spending nights outside home | Conduct disorder ADHD (inattentive type) | Brain MRI not done |
7 | Cerebral malaria | Male | 3.9 | Fears being alone; cries often, aggressive to peers and easily confused | Separation anxiety disorder | Generalised widening of sulcal spaces and sylvian fissures and numerous bilateral hyperintensities in the grey mater and subcortical regions of the frontal, occipital and temporal lobes |
8 | Cerebral malaria | Male | 6.9 | Irritable, aggressive towards siblings, sucking thumb | Adjustment disorder (current) | Bilateral hyper-intensities around the frontal horns of the lateral ventricles—largest measuring 5-7 mm and also the temporal and occipital horns. No oedema or restricted diffusion on DWI |
9 | Cerebral malaria | Female | 2.0 | Feeding problems, weight loss, fearful, quiet and plays alone, nightmares. Separated from parents | Major depression (current) | Normal brain MRI |
10 | Cerebral malaria | Male | 2.7 | Defiant and indifferent—not caring attitude, labile mood, disorganised, misplaces objects | Oppositional defiant disorder | Brain MRI not done |
11 | Cerebral malaria | Male | 3.0 | Loss of interest; poor concentration and irritability | Major depression (current) | Normal brain |
12 | Cerebral malaria | Male | 2.6 | Hyperactive aggressive | Oppositional defiant disorder | Normal brain |
13 | Cerebral malaria | Female | 2.1 | Irritable, aggressive, self injurious behaviour, head banging, excessive crying, temper tantrums, regression in speech | Oppositional defiant disorder Also has epilepsy, bilateral hyperreflexia and upgoing babinksi reflexes and learning disability | High signal white mater intensities on T2 weighted imaging and FLAIR (iso-intense on T1 WI) |
14 | Cerebral malaria | Male | 3.2 | Violent and aggressive behaviour stealing | ADHD Conduct disorder Has severe sequelae with visual, hearing, speech impairment, epilepsy and learning difficulties | Marked global brain atrophy involving the cerebral hemispheres, midbrain, brainstem and cerebellum and reduced grey-white mater differentiation. Focal encephalomalacia in both occipital lobes and demyelination with extensive T2 W and T2FLAIR white mater peri-ventricular hyperintensities and in the right external capsule, cerebellae penducle and cerebellar hemispheres |
15 | Cerebral malaria | Female | 7.1 | Fearfulness, very slow, irritable, quiet, frequent headaches | Major depression (current) also has some anxiety symptoms and learning difficulties | Normal brain |
16 | Cerebral malaria | Male | 6.9 | Worsening episodes of aggressive behaviour; fighting, resists change, forgetful, cries often, throws stones; enuresis | ADHD inattentive type; conduct disorder | Bilateral hyper-intensities around the parietal and occipital areas—largest measuring 2–3.7 mm and also the temporal and occipital horns. No oedema or restricted diffusion on DWI |
17 | Cerebral malaria | Male | 3.5 | Wets himself during day; Isolates himself and hides, quiet most of the time | Separation anxiety disorder. Major depression (current) | Bilateral punctuate white mater high T2 signal foci (hypo-intense on T1 WSE) measuring 1.5-2.0 mm in the parietal regions. No restriction of water diffusion on DWI |
18 | Cerebral malaria | Female | 9.0 | Forgetfulness, fearful and reduced concentration; declining academic performance and often punished | ADHD combined | Normal brain |