Editorial Cerebral Malaria

A patient with proved or suspected falciparum malaria who loses consciousness is in urgent need of antimalarial drugs (given by intravenous infusion), close observation, and, if possible intensive care [1]. Use of the term cerebral malaria emphasizes the gravity of the situation, but for the purposes of clinical research and to make reports from different geographical areas comparable, a more rigorous definition is required. Cerebral malaria is an encephalopathy associated with the sequestration of parasitized erythrocytes in cerebral venules and capillaries [2,3]. It must be distinguished from the effects of high fever per se, such as minor disturbances of consciousness (drowsiness, obtundation, confusion, irritabi-lity), and the transient post-ictal coma which follows febrile convulsions in children. The wide range of neurological signs, sequelae and case mortality rates reported in the literature before 1980 suggested imprecision in the definition and diagnosis of cerebral malaria. In Thailand, we attempted to overcome this problem by defining the level of unconsciousness using the Glasgow Coma Scale [4], by requiring proof of acute P. falciparum infection by finding asexual forms of the parasite, and by excluding other locally important encephalo-pathies such as viral, bacterial and fungal meningoencephalitides, eclampsia, cerebrovascu