Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Cerebral malaria
Introduction
Overview
Overview
- 5% of the world’s population is parasitized by malaria at any given time
- 0.5-2.5 million deaths per year
- Nearly all deaths (and neurologic complications) caused by Plasmodium falciparum
- Cerebral Malaria – Case Definition
- Deep level of unconsciousness with inability to localize a painful stimulus
- P. falciparum asexual parasitemia
- Hypoglycemia and other encephalopathies have been excluded
- Coma should persist >6 hours in adults and >1 hour in children after a seizure
- Deep level of unconsciousness with inability to localize a painful stimulus
Pathophysiology & Etiology
Pathophysiology & Etiology
- Based on Age and Prior Exposure
- < 2 years old – severe anemia
- 2-18 years old – seizures/cerebral malaria
- >18 years old – acute renal failure, pulmonary edema, liver dysfunction, cerebral malaria
- All – metabolic acidosis (lactate)
- Vector
- Female Anopheles Mosquito
- What’s in the Smear?
- Ring forms mostly (occ banana gametocytes) – because trophozoites and schizonts are sequestered in vascular beds, causing pathology
- Pathology
- Sequestration of parasitized red blood cells (RBCs) in relatively hypoxic venous beds allows optimal parasite growth and prevents splenic destruction
- Peripheral parasite count relatively poor predictor of sequestered biomass
- Parasitized RBCs have electron dense “knobs” on surface, thought to be mediators of cytoadherence
- Antigenic variation of “knobs” allow immune evasion
- Decreased deformability of RBCs
- Increased tumor necrosis factor (TNF) production
History and Symptoms
History and Symptoms
- Diffuse encephalopathy
- Febrile, unconscious, variable tone, usually lacking focal neurologic signs
- No rash, no lymphadenopathy
- Hypoglycemia common (8% adults, 20% children)
- Seizures (10-50%)
- Mortality 20% (8% ->50% if concomitant with renal failure and metabolic acidosis)
- Most deaths occur within 48 hours of admission
- Full recovery of consciousness takes a median of 2 days, but can take >1 week
Treatment
Treatment
- Supportive
- IV Quinine (in US, Quinidine 10-20 mg/kg load followed by 0.02 mg/kg/min drip over 72 hours
- Blood transfusion for hematocrit < 20
- Correct hypoglycemia (but does not improve neurologic recovery)
Contraindicated Medications
Future or Investigational Therapies
Future or Investigational Therapies
- Artemisin derivatives may replace quinine in the future
- Exchange transfusion?
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]