Most deaths in children with cerebral malaria may be due to increased brain volume leading to raised intracranial pressure, according to research from Malawi.

Therefore, a therapeutic approach “that capitalizes on the fact that, in survivors, the brain swelling resolves over one to two days, would be to treat the effect of brain swelling, which is respiratory arrest,” Dr. Terrie E. Taylor, of Michigan State University in Lansing told Reuters Health by email.

In fact, she concluded, “It may be that providing ventilatory support would be enough to, in effect, tide the children over the vulnerable period.”

In a March 19 online paper in The New England Journal of Medicine, Dr. Taylor and colleagues note that case fatality rates among African children with cerebral malaria remain in the range of 15% to 25%.

Magnetic resonance imaging (MRI) became available in Malawi in 2009, and the team used it to investigate the role of brain swelling in 168 children with the disease.

In all, 25 (15%) of these children died, including 21 (84%) with evidence of severe brain swelling on MRI at admission. However, severe brain swelling was seen in only 39 (27%) of the 143 survivors. In addition, serial MRI scans showed evidence of decreasing brain volume in the survivors who had brain swelling initially.

“Among survivors, the volume increase was transient, and the long-term outcomes were similar to those observed in survivors with normal brain volumes, suggesting that interventions that decrease brain swelling or sustain respiration temporarily, while the brain is swollen, may reduce mortality without increasing morbidity,” the authors conclude.