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
Sciences
