Cerebral MalariaBy

Dr Tanveer alam khan

Malaria Threatens 40% world population

What is malaria?What is cerebral malaria?How malaria spreads?pathophysiology ?What are clinical features?Differential diagnosis?How to diagnoseManagementprognosis

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Malaria is a disease of the blood that is caused by the Plasmodium parasite, which is transmitted from person to person by a particular type of mosquito

female Anopheles mosquito is the only mosquito that transmits malaria.

She primarily bites between the hours of 9pm and 5am,

Transmission/ cause

A strict definition of cerebral malaria has been recommended for sake of clarity

“this requires the presence of unarousable coma, exclusion of other encephalopathies and confirmation of P. falciparum infection”

This requires the presence of P. falciparum parasitemia and the patient to be unrousable with a Glasgow Coma Scale score of 9 or less, and other causes (e.g. hypoglycemia, bacterial meningitis and viral encephalitis) ruled out. To distinguish cerebral malaria from transient postictal coma, unconsciousness should persist for at least 30 min after aconvulsion. 

Cerebral malaria definition

Mechanical hypothesis:Rostting/cytoadherence The basic underlying defect clogging of the cerebral

micocirculation by the parasitized red cells. These cells develop knobs on their surface and develop increased cytoadherent properties, as a result of which they tend to adhere to the endothelium of capillaries and venules.

pathophysiology

Earliest Manifestations – FeverLoss of AppetiteVomitingCough

Specific for Cerebral MalariaImpaired consiousnessGen. Convulsion with SequelaelComa > 30min

 Lumbar puncture Thick filmThin filmIct malariaPCRThe malarial retinopathy 1)retinal whitening 2)vessel changes, 3)retinal hemorrhages 4) papilledema. The first two of these abnormalities are specific to malaria,

and are not seen in other ocular or systemic conditions

diagnosis:

Maintain a clear airway. In cases of prolonged, deep coma, endotracheal intubation may be indicated.

Turn the patient every two hours. Avoid soiled and wet beds. Comatose patients should be placed in a semirecumbent position to reduce

the risk for aspiration. Naso-gastric aspiration to prevent aspiration pneumonia. Maintain strict intake/output record. Observe for high coloured or black urine. Monitor vital signs every 4-6 hours. Changes in levels of sensorium, occurrence of convulsions should also be

observed. If the temperature is above 390 C, tepid sponging and fanning must be done. Serum sodium concentration, arterial carbon dioxide tension, blood glucose,

and arterial lactate concentration should be monitored frequently. Urtheral cathetarization Seizures should be treated promptly with anticonvulsants, but their

prophylactic use is still in dispute.[1] Diazepam by slow intravenous injection, (0.15 mg/kg, maximum of 10 mg)

management

ACT (artesunate +amodiaquine or artemether-lumefantrine

Cerebral malaria is a life threatening complication of malaria. It affects

children more than adult and should be considered in any patient with

impairment of consciousness. The mortality rate is high and asignificant number of childhood survivors suffer from transientneurological deficit at discharge and subtle long-term cognitivedeficiencies. High index of suspicision is needed for early

diagnosis andeffective treatment. Urgent treatment with antimalarial drug is

required,but the prognosis often depends on the management of

complications.

Cerebral Malaria is a fatal diseaseStrict criterion needs to be followed before

establishing diagnosis for cerebral malariaHospital admission with ICU is requiredCerebral malaria has poor prognosis

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