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Overview :
Beare et al developed an algorithm for the use of malarial
retinopathy in the evaluation of a comatose child with malaria. In an area
endemic for malaria coma may be due to a cause other than the malaria. The
authors are from Blantyre (Malawi), Royal Liverpool University, Michigan State
University, and Tumaini University in Moshi, Tanzania.
Patient selection: comatose child with malarial parasitemia
The child's fundus is examined for findings of malarial
retinopathy:
(1) papilledema
(2) retinal whitening
(3) vascular changes
(4) retinal hemorrhages
(5) cotton wool spots
If malarial retinopathy is diagnosed, then it is graded as mild,
moderate or severe.
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Results of Fundus
Exam |
Interpretation |
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normal |
evaluate for other causes of coma; treat for
malaria |
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papilledema only (without other changes) |
evaluate for other causes of raised intracranial pressure;
treat for malaria |
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malarial retinopathy |
confirms diagnosis of cerebral malaria; treat for
malaria |
Poor prognostic findings - one or both of the following
(1) severe malarial retinopathy
(2) malarial retinopathy with papilledema
The number of retinal hemorrhages correlates with the number of
cerebral hemorrhages.
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