Changes may be seen in:
(1) arterioles
(2) capillaries
(3) venules
Arterioles and venules may show:
(1) tram-lining (with an orange or white color at the outer edges of the vessel)
(2) irregularities of the luminal margin
(3) solid white or orange coloration across the entire width
True tram-lining must be distinguished from a variety of mimics.
Capillaries may show whitening of the capillary network:
(1) These may look like lace or patches of frosting.
(2) These may occur within patches of peripheral retinal whitening.
Vascular changes may be limited or extensive.
vessel changes score =
= (number of quadrants with vessel changes) / (number of quadrants visualized)
Interpretation:
• The vessel changes score ranges from 0 to 1.
• The presence of vessel changes is a sign of cerebral malaria.
• The presence of vessel changes may be associated with increased mortality, especially when extensive.
