P falciparum malaria infections in children in endemic areas usually just cause a feverish illness. But occasionally such an infection can lead to serious complications, the gravest of which is called ‘cerebral malaria’ (CM) because the child becomes comatose and develops convulsions (fits).
About one in five children with CM will die, even if treated skillfully. Why death occurs has been a mystery, partly because it is so difficult to observe what happens within the brain. But magnetic resonance imaging (MRI), usually not available in malarious areas, has recently been available in Blantyre, Malawi, and has provided a possible solution to the mystery: the brain is swollen in CM, and much more so in those who die than in those who survive.