Cerebral malaria: clinical features and diagnosis

The African Journal of Neurological Sciences Vol 17 No.1, 1998 Cerebral malaria: clinical features and diagnosis. SCHMUTZHARD E. Code Number: NS98001 SUMMARY Celebral Malaria is the most important course of P.falciparum infection with mortality rates of up to 50%. The clinical criteria consist of unarousable coma, exclusion of other encephalopathies and the confirmation of P.falciparum infection. Beside unarousable coma in up to 80% epileptic seizures are observed in cerebral malaria. Frequently other organs are involved parallel dysfunction. The golden standard of therapy for severe P.falciparum malaria, incl. cerebral malaria, is intravenous quinine dihydrochloride. Although anticonvulsive therapy is recommended, there is no real scientific proof that such therapy in cerebral malaria given prophylactically will improve the outcome. The same applies to low molecular weight dextrane, full scale heparinisation or dexamethasone, pentoxifylline, given as adjuctive therapy, possibly provides a therapeutic value in cerebral malaria. Besides the mortality rate, neurological sequelae until recently often denied, can occur on average in up to 7% of patients with cerebral malaria, protracted convulsions prolonged coma and severe anemia being frequently associated with the development of neurological sequelae. RESUME La paludisme cerebral est la plus importante complication de l'infection a P. falciparum. Sa mortalite depasse 50%. Les criteres cliniques reposent sur un coma profond, l'elimination d'autres encephalopathies et la confirmation de l'infection Par P. falciparum. Au cours du coma, on observe don 80% des cas des crises d'epilepsie. D'autres organes sont consrnes en fonction de l'atteinte cerebrale. La regle d'or du traitement du paludisme a P. falciparum et du paludisme cerebral est le dihydrochloride de quinine intaveineux. Bien que le traitement anticonvulsif soit recommended il n'y a pas de preuve scientifique que dans ce cas un tel traitement soit benefique. Il en va de meme pour la dextrane de faible poids moleculaire, l'heparinisation a dose elevee ou la dexamethasone. La pentoxifylline en traitement d'appoint du paludisme cerebral presenterait un certain interet. En plus de la mortalite des sequelles neurologiques souvent contestees encore recemment peuvent apparaitre. 7% des patients atteints de paludisme cerebral avec coma profond, convulsions prolongees et une anemic importante sont frequemment atteints de sequelles neurologiques. KEY WORDS: Cerebral Malaria - diagnosis clinical features. Copyright 1998 Pan African Association of Neurological Science