General description

Malaria is a parasite transmitted by the Anopheles mosquito, which is widely distributed in the tropics and subtropics. Cerebral malaria (CM) represents one of the most severe complications of Plasmodium falciparum infection, resulting in significant mortality worldwide, particularly in children from sub-Saharan Africa.

Cerebral malaria is clinically characterized as a diffuse encephalopathy with a history of fever for 2-3 days, subsequent seizures, and loss of consciousness (coma). The World Health Organization defines cerebral malaria as a clinical syndrome characterized by coma at least 1 hour after termination of a seizure or correction of hypoglycemia.

The initial manifestations of CM are often non-specific, including fever, chills, irritability, agitation or psychotic behavior, vomiting, and cough. As the disease progresses, patients develop more severe manifestations, including impaired consciousness with coma, generalized convulsions, and neurological sequelae.

There are substantial differences in the clinical manifestations between children and adults. In African children, coma typically develops suddenly with seizure onset, following 1-3 days of fever. Pediatric CM usually manifests with coma, seizures, and severe anemia, while renal failure and respiratory distress rarely occur. Compared with adults, children have a higher incidence rate of seizures, including focal motor and generalized tonic-clonic convulsions, as well as subtle or subclinical seizures detected with electroencephalography.

Adult CM is frequently associated with multiple organ complications, including central nervous system dysfunction, liver dysfunction, respiratory failure, and acute kidney failure. Other complications in adults include severe jaundice, respiratory distress syndrome, and severe intravascular hemolysis leading to hemoglobinuria and anemia, which further contributes to renal failure. Most seizures in adult CM patients are generalized seizures, although focal motor seizures may also occur.

Brain swelling, intracranial hypertension, retinal changes (hemorrhages, peripheral and macular whitening, vessel discoloration and/or papilledema), and brainstem signs (abnormalities in posture, pupil size and reaction, ocular movements, or abnormal respiratory patterns) are commonly observed in CM patients. Systemic complications such as anemia, metabolic acidosis, electrolyte imbalance, hyperpyrexia, hypoglycemia, and shock are also commonly present.

References

1. El Beltagi, Ahmed, et al. "Imaging features of fulminant cerebral malaria: A case report." Radiology Case Reports 18.10 (2023): 3642-3647.