{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:09:54Z","timestamp":1753891794833,"version":"3.41.2"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cerebral malaria (CM) is a devastating disease and better understanding of etiologies of the resulting neurologic injury is needed. The purpose of this study is to describe the day-to-day (DTD) pulsatility index (PI) change measured by transcranial Doppler ultrasound (TCD), a novel measure of cerebral and vascular changes, in children with CM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of 122 children in sub-Saharan Africa with CM and 3 or more sequential TCD measurements was performed. Variability of DTD PI change was calculated as a measure of changes in vasculature overtime. Neurologic outcome was determined by the Pediatric Cerebral Performance Category (PCPC) score, a measure of neurologic function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 122 participants, 77.9% had a good neurologic outcome (no neurologic sequelae), and 22.1% had a poor outcome (neurologic sequelae or died). Patients who had a poor neurologic outcome had higher levels of variability of DTD PI change in the right middle cerebral artery (MCA) (0.14 \u00b1 0.21) and left MCA (0.17 \u00b1 0.41) compared to those who had a good neurologic outcome (0.1 \u00b1 0.1 and 0.11 \u00b1 0.19, respectively). A higher variability of both left and right MCA DTD PI change was also associated with higher brain volume assessed through neuroimaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Variability of DTD PI change may provide early prognostic information regarding PCPC outcomes and brain volume changes seen in CM patients. Expanded research on pathophysiologic contributors to variability of DTD PI changes in children with CM is warranted.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1466941","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T06:10:55Z","timestamp":1731305455000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Variability of day-to-day pulsatility index change in children with cerebral malaria"],"prefix":"10.3389","volume":"15","author":[{"given":"Jeremy","family":"Jordan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"O\u2019Brien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davin Ambitapio","family":"Musungufu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert Tandjeka","family":"Ekandji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Pongo","family":"Mbaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludovic","family":"Mayindombe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Buba","family":"Giresse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tusekile","family":"Phiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvester","family":"June","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Montfort Bernard","family":"Gushu Co","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taty","family":"Tshimanga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Reuter-Rice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,11]]},"reference":[{"volume-title":"World malaria report 2022","year":"2023","key":"ref1"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12936-018-2272-y","article-title":"Cerebrospinal fluid Plasmodium falciparum histidine-rich protein-2 in pediatric cerebral malaria","volume":"17","author":"Thakur","year":"2018","journal-title":"Malar J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e153","DOI":"10.1016\/S2214-109X(13)70060-3","article-title":"Viral CNS infections in children from a malaria-endemic area of Malawi: a prospective cohort study","volume":"1","author":"Mallewa","year":"2013","journal-title":"Lancet Glob Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1086\/505078","article-title":"The distribution and intensity of parasite sequestration in comatose Malawian children","volume":"194","author":"Seydel","year":"2006","journal-title":"J Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1038\/nm986","article-title":"Differentiating the pathologies of cerebral malaria by postmortem parasite counts","volume":"10","author":"Taylor","year":"2004","journal-title":"Nat Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1093\/infdis\/jir812","article-title":"Sequestration and microvascular congestion are associated with coma in human cerebral malaria","volume":"205","author":"Ponsford","year":"2012","journal-title":"J Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.pt.2006.09.002","article-title":"A unified hypothesis for the genesis of cerebral malaria: sequestration, inflammation and hemostasis leading to microcirculatory dysfunction","volume":"22","author":"van der Heyde","year":"2006","journal-title":"Trends Parasitol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/S0140-6736(12)60034-8","article-title":"Global malaria mortality between 1980 and 2010: a systematic analysis","volume":"379","author":"Murray","year":"2012","journal-title":"Lancet"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1111\/j.1365-3156.2005.01505.x","article-title":"A review of the quality of randomized clinical trials of adjunctive therapy for the treatment of cerebral malaria","volume":"10","author":"Enwere","year":"2005","journal-title":"Trop Med Int Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1016\/S1474-4422(10)70270-2","article-title":"Blantyre malaria project epilepsy study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study","volume":"9","author":"Birbeck","year":"2010","journal-title":"Lancet Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e20181026","DOI":"10.1542\/peds.2018-1026","article-title":"Neurodevelopmental impairments 1 year after cerebral malaria","volume":"143","author":"Langfitt","year":"2019","journal-title":"Pediatrics"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.jpeds.2018.07.075","article-title":"Transcranial Doppler ultrasonography provides insights into neurovascular changes in children with cerebral malaria","volume":"203","author":"O\u2019Brien","year":"2018","journal-title":"J Pediatr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"769","DOI":"10.3171\/jns.1982.57.6.0769","article-title":"Noninvasive transcranial doppler ultrasound recording of flow velocity in basal cerebral arteries","volume":"57","author":"Aaslid","year":"1982","journal-title":"J Neurosurg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1007\/s00381-011-1476-z","article-title":"Cerebrovascular response in children following severe traumatic brain injury","volume":"27","author":"Adelson","year":"2011","journal-title":"Childs Nerv Syst"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s12936-022-04163-0","article-title":"Mechanisms of transcranial Doppler ultrasound phenotypes in paediatric cerebral malaria remain elusive","volume":"21","author":"O\u2019Brien","year":"2022","journal-title":"Malar J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/S0301-5629(98)00024-6","article-title":"Gosling\u2019s Doppler pulsatility index revisited","volume":"24","author":"Michel","year":"1998","journal-title":"Ultrasound Med Biol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.7863\/jum.2003.22.10.1049","article-title":"Monitoring of increased intracranial pressure resulting from cerebral edema with transcranial Doppler sonography in patients with middle cerebral artery infarction","volume":"22","author":"Asil","year":"2003","journal-title":"J Ultrasound Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/foc.2000.8.1.1702","article-title":"Evaluating the outcome of severe head injury with transcranial doppler ultrasonography","volume":"8","author":"Moreno","year":"2000","journal-title":"Neurosurg Focus"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s10143-013-0453-2","article-title":"Decompressive craniectomy and head injury: brain morphometry, ICP, cerebral hemodynamics, cerebral microvascular reactivity, and neurochemistry","volume":"36","author":"Bor-Seng-Shu","year":"2013","journal-title":"Neurosurg Rev"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"201","DOI":"10.5603\/MRJ.a2020.0016","article-title":"Clinical application of pulsatility index","volume":"5","author":"Wielicka","year":"2020","journal-title":"Med Res J"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1089\/neur.2022.0035","article-title":"Association between Day-to-Day Pulsatility index change and neurocognitive outcomes in pediatric traumatic brain injury","volume":"3","author":"Jordan","year":"2022","journal-title":"Neurotrauma Reports"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1097\/JNN.0000000000000533","article-title":"Day-to-day change in pulsatility index describes anterior cerebral circulation disturbance and functional outcomes in pediatric traumatic brain injury","volume":"52","author":"Jordan","year":"2020","journal-title":"J Neurosci Nurs"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1056\/NEJMoa1400116","article-title":"Brain swelling and death in children with cerebral malaria","volume":"372","author":"Seydel","year":"2015","journal-title":"N Engl J Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/S0022-3476(05)82544-2","article-title":"Assessing the outcome of pediatric intensive care","volume":"121","author":"Fiser","year":"1992","journal-title":"J Pediatr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1097\/00003246-200004000-00043","article-title":"Relationship of illness severity and length of stay to functional outcomes in the pediatric intensive care unit: a multi-institutional study","volume":"28","author":"Fiser","year":"2000","journal-title":"Crit Care Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1007\/s11910-022-01214-6","article-title":"Neurological complications of malaria","volume":"22","author":"Trivedi","year":"2022","journal-title":"Curr Neurol Neurosci Rep"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1466941\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T06:10:57Z","timestamp":1731305457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1466941\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,11]]},"references-count":26,"alternative-id":["10.3389\/fneur.2024.1466941"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1466941","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2024,11,11]]},"article-number":"1466941"}}