A schematic diagram showing changes in and around a cerebral vessel with sequestration of pRBCs. Cytoadherence of parasitized erythrocytes to the endothelial cell lining and sequestration of parasitized and non-parasitized cells in the cerebral capillary or post capillary venule initiates an inflammatory process, endothelial activation, release of endothelial microparticles and apoptosis in the exposed area. At the site of cytoadherence, the blood brain barrier is possibly disrupted and there is an increased inflammatory response in the perivascular area with an increased release of pro-inflammatory cytokines.

Day 1 (admission is day 0): A. Color fundus photograph of a child with cerebral malaria; multiple retinal hemorrhages are visible. No major change from admission. B. Fluorescein angiography shows multiple areas of retinal non-perfusion. These are more clearly delineated than on day 0 (admission). C. At higher magnification and later in the angiography run, there is some mild leakage round the border of the perfused and non-perfused zones. The leakage may suggest dysfunction of the blood-retina barrier. Day 3 of coma: D. There is little change in appearance compared to day 1. E. But there is substantial recovery in areas of non-perfusion. F. At higher magnification and later in the angiography run, leakage of fluorescein from re-perfused capillaries and capillaries previously on the border of non-perfusion is still observed. Photographs courtesy of Dr Nicholas Beare - Royal Liverpool University Hospital and the Wellcome Trust - Liverpool School of Hygiene and Tropical Medicine Program in Malawi.