From the Research
Cerebrospinal fluid (CSF) in cerebral malaria is typically characterized by minimal abnormalities, with the most recent and highest quality study suggesting that CSF biomarkers provide evidence for kidney-brain axis involvement in cerebral malaria pathogenesis 1.
Key CSF Findings
- The CSF is usually clear with normal or mildly elevated opening pressure, as seen in a study where the mean opening pressure was 22.6 cm CSF, although this study is older and not as relevant to current practice 2.
- Cell counts are generally normal or show only slight pleocytosis (fewer than 20 white blood cells/μL).
- Protein levels are typically normal or mildly elevated (rarely exceeding 100 mg/dL).
- Glucose concentration remains within normal limits, although one study found that patients with cerebral malaria had significantly lower CSF glucose levels compared to controls 3.
Pathophysiology and Diagnostic Considerations
The normal CSF profile in cerebral malaria occurs because the pathophysiology primarily involves sequestration of parasitized red blood cells in cerebral microvasculature rather than direct invasion of the CSF space by the Plasmodium falciparum parasite. This vascular sequestration leads to microcirculatory obstruction, endothelial activation, and blood-brain barrier dysfunction without significant inflammation in the CSF itself.
Recent Evidence and Clinical Implications
A recent study found that acute kidney injury (AKI) is associated with increases in CSF markers of impaired blood-brain-barrier function, neuronal injury, and excitatory neurotransmission in children with cerebral malaria 1. This suggests that the kidney-brain axis may play a role in the pathogenesis of cerebral malaria, and that CSF biomarkers may be useful in diagnosing and monitoring the disease.
Clinical Recommendations
In clinical practice, CSF findings in cerebral malaria should be interpreted alongside blood smears showing P. falciparum parasitemia and the characteristic clinical presentation of impaired consciousness in a patient from or traveling to an endemic area 1.