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.
Results of Fundus Exam
Interpretation
normal
evaluate for other causes of coma; treat for malaria
papilledema only (without other changes)
evaluate for other causes of raised intracranial pressure; treat for malaria
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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