Abstract
The neurological findings of 100 patients of adult cerebral malaria were studied. The commonest neurological feature was symmetrical upper motor neuron lesion as evidenced by exaggerated tendon reflexes and bilateral planter extensor (61%). Twenty two percent had features of meningeal irritation and/or meningism. Abnormal posturing occurred decerebrate rigidity (6%) and decorticate rigidity (4%) with or without opisthotonus, focal neurological deficit was noted in 5% cases. Pupillary size and reaction were normal in 86%, poor in 14%. Corneal reflexes were absent in 4% cases. Fundoscopy showed retinal hemorrhage in 16%, papilloedema is 3% and exudates in 1%. Majority of the patients recovered (80%) without any persistent neurological sequelae at the time of discharge from hospital and death rate was 20%. Patients having focal neurological deficit, disconjugate gaze, poor pupillary reaction, absent corneal reflex and papilloedema were more susceptible to death. Delay in hospitalization and deep coma were also associated with increased mortality, whereas early hospitalization and proper nursing care could reduce mortality.
Highlights
Malaria is the most important parasitic disease in man
This definition requires the presence of unrousable coma using the Glasgow Coma Scale (GCS), exclusion of other encephalitides, especially bacterial meningitis and if possible, locally prevalent encephalitis and the finding of asexual forms of P. falciparum in the blood film
Majority of the cerebral malaria cases occurred in males in their active period of life incurring great financial loss to their families and to the nations
Summary
Malaria is the most important parasitic disease in man. It is estimated that 110 million clinical cases of malaria and between one and two million deaths associate with Plasmodium falciparum occur each year worldwide[1]. Cerebral malaria is the most important complication of falciparum malaria and the leading cause of death in malaria[2,3]. The World Health Organization has laid down definite guideline for diagnosis and management of cerebral malaria[5]. This definition requires the presence of unrousable coma using the Glasgow Coma Scale (GCS), exclusion of other encephalitides, especially bacterial meningitis and if possible, locally prevalent encephalitis and the finding of asexual forms of P. falciparum in the blood film. The study was conducted to see the neurological findings and outcome in adult cerebral malaria cases and to compare those findings between the death and survivors
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