Cerebral Malaria

Overview

Cerebral malaria is the commonest complication and one of the cause of death in severe plasmodium falciparum infection. To be diagnosed as cerebral malaria, patients must be have unarousable coma, confirmation of plasmodium falciparum infection and exclusion of other encephalopathies.

Signs and Symptoms

Unarousable coma with Glasgow coma scale of less than 7, Mild neck stiffness, Abnormalities in eye movements such as dysconjugate gaze, Retinal haemorrhage, Fixed jaw closure and tooth grinding, Pouting, Decerebrate and decorticate rigidity, Jaundice, Anemia, Hepatosplenomegaly

Common Causes

Plasmodium falciparum infection, Clogging of the cerebral microcirculation with parasitised red blood cells,

Risk Factors

Living in or travelling to areas where malaria is common such as African countries, Low socioeconomic status, Little or no access to health care, Lack of knowledge of the disease, Infants, young children and old people, Travellers from areas with no malaria, Pregnant women and their unborn child

Investigation Techniques

Medical history,Physical examination, Full blood count, Thick and thin blood smears, Rapid diagnostic tests, Polymerase chain reaction (PCR), Serology tests, Lumbar puncture, Cerebrospinal fluid analysis, Electroencephalogram (EEG), Computed tomography (CT) scan of the brain, Magnetic resonance imaging (MRI) scan of the brain

Treatment and Prevention

Parenteral artemisinin derivatives or quinine, Anticonvulsants such as diazepam and paraldehyde, Blood transfusion, Correction of fluids, electrolytes and acid base balance, Supportive therapy such as artificial ventilation, nasogastric aspiration, hemodialysis or hemofiltration, Management of associated complications