29 March, 2005
Case Study (Click here)
Exclusive to Plasmodium falciparum
Especially pregnant women, nonimmune individuals, children
Characterised by headache, seizures, coma & rarely hemiplegia, aphasia, hemianopia, cerebellar ataxia, other focal neuro signs.
1. Mechanical obstruction
2. Disseminated vasculomyelinopathy from a neuroallergic reaction (Poser)
-vasculopathy affecting myelin system leading to perivascular demyelination.
Vasculopathy: changes in permeability leading to perivascular & parenchymatous
endothelial thickening, vein wall necrosis, microthrombosis,
Myelinoclasia & reactive gliosis: perivascular demyelination, reactive gliosis,
CSF: normal pressure
Slight increase protein
Glucose may be reduced
Periventricular hyperintensity; sometimes gadolinium hyperintensity.
EEG: posterior parieto-temporal discharges most common finding
75% complete recovery
5% neurologic sequelae
Postmalaria Neurologic Syndrome
Acute onset of confusion or epileptic seizures, occurring in a patient without parasitemia, with a latency of several days to weeks, after recovery from successfully treated malaria.
1. localized form with isolated tremor or cerebellar ataxia
2. mild encephalopathy with acute confusion or seizures
3. severe, steroid responsive encephalopathy with motor aphasia, generalized myoclonus, tremor & ataxia.
Adverse prognostic markers:
Delay in diagnosis / nondiagnosis
Deep coma with extensor posturing
Absent brainstem reflexes
< 3 yo
high CSF lactate
Low serum glucose
Severe metabolic acidosis
Steroids not beneficial & may be harmful
Anti TNF antibodies – useless
Pentoxifylline – useless
Desferroxamine - useless