Haemodynamics in children with acute non-traumatic coma

Cerebral malaria, meningitis and encephalitis are the most common causes of acute encephalopathies in children in sub-Saharan Africa. All are associated with seizures and may be complicated by shock and intracranial hypertension. These features are associated with prolonged coma, increased mortality and both short and long-term cognitive and neurological deficits. Children with multiple risk factors have even poorer outcomes.

Seizures may be completely unapparent clinically. Clinical signs of intracranial hypertension are a late feature and intracranial pressure monitoring is an invasive procedure unavailable in most health units in sub-Saharan Africa.

We are exploring the utility of a non-invasive tool for measuring intracranial pressure, the tympanic membrane displacement analyzer, in monitoring children with infectious encephalopathies. Using continuous Electroencephalographic monitoring and trans-cranial Doppler ultrasound, we also seek to describe the seizure semiology and the cerebral haemodynamics of these patients. We expect that these observations will provide insight into the mechanisms of brain damage in these diseases and help guide future interventional studies.