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Children with MR (n\u2009=\u200943) underwent ophthalmoscopy, fluorescein angiography and HH-OCT during admission, 1-month (n\u2009=\u200931) and 1-year (n\u2009=\u20098) post-discharge. Controls were comatose patients without malaria (n\u2009=\u20096) and age\/sex-matched healthy children (n\u2009=\u200943). OCT changes and retinal layer thicknesses were compared. On HH-OCT, hyper-reflective areas (HRAs) were seen in the inner retina of 81% of MR patients, corresponding to ischaemic retinal whitening on fundus photography. Cotton wool spots were present in 37% and abnormal hyper-reflective dots, co-localized to capillary plexus, in 93%. Hyper-reflective vessel walls were present in 84%, and intra-retinal cysts in 9%. Vascular changes and cysts resolved within 48\u00a0h. HRAs developed into retinal thinning at 1 month (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.027) which was more pronounced after 1\u00a0year (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.009). Ischaemic retinal whitening is located within inner retinal layers, distinguishing it from cotton wool spots. Vascular hyper-reflectivity may represent the sequestration of parasitized erythrocytes in vessels, a key CM feature. The mechanisms of post-ischemic retinal atrophy and cerebral atrophy with cognitive impairment may be similar in CM survivors. HH-OCT has the\u00a0potential for monitoring patients, treatment response and predicting neurological deficits.\n                  <\/jats:p>","DOI":"10.1038\/s41598-021-94495-9","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T06:06:43Z","timestamp":1627970803000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Cerebral malaria: insight into pathology from optical coherence tomography"],"prefix":"10.1038","volume":"11","author":[{"given":"Zhanhan","family":"Tu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Gormley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viral","family":"Sheth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl B.","family":"Seydel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terrie","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Beare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Barrera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank A.","family":"Proudlock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chatonda","family":"Manda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Harding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Gottlob","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"94495_CR1","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1056\/NEJMoa1400116","volume":"372","author":"KB Seydel","year":"2015","unstructured":"Seydel, K. 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