What is Cerebral Malaria

We are all aware of what is malaria and the causes of malaria. This is a mosquito borne infectious disease. It is caused by injection of the eukaryotic protist Plasmodium into the veins by the bite of the female Anopheles mosquito. There are 5 species of the plasmodium parasite that can infect humans. These include Plasmodium vivax, Plasmodium ovale and Plasmodium malariae; that cause milder forms of malaria in humans. Plasmodium falciparum causes a more serious form of the disease. The fifth parasite is a zoonosis, Plasmodium knowlesi, infects macaques, but can also cause disease in humans. One of the rapidly developing encephalopathy is cerebral malaria. This a very dangerous condition that can cause brain damage and coma.

What is Cerebral Malaria?
The most common non-traumatic encephalopathy around the world is cerebral malaria. It occurs due to the clinical manifestations of Plasmodium falciparum that causes changes in the mental state of the infected person as well can lead to coma. This is an acute condition that affects the brain. It is the most common complication of malaria and can lead to death in severe cases of infection.

Studies have shown that about 10% of all patients of malaria are infected with falciparum malaria and over 80% of deaths occur due to the brain infection. The mortality rate is between 25 to 50% and if not treated promptly, it can cause death within 24 to 72 hours of infection. The most prominent histopathological characteristic of cerebral malaria is the segregation of the cerebral capillaries and venules with parasitized red blood cells (PRBC) and non-parasitized red blood cells (non-PRBC). One will see ring like lesions in the brain.

Cerebral Malaria Symptoms
It is very important to identify the symptoms of malaria early on, because if the disease progresses to cerebral malaria, it can lead to death within 24 to 72 hours. The symptoms of malaria include:

• Chills
• Headache
• Fever
• Myalgia
• Hypotension
• RBC sludging

If the disease progresses of cerebral malaria, symptoms include:

• High fever due to unknown causes
• Convulsions
• Loss of consciousness
• Changes in the neurological behavioral pattern
• Headache
• Orthostatic hypotension
• Coma, where the patient yo-yo's between arousable and unarousable stages

The cerebral malaria symptoms undergo three different stages as follows:

• Cold stage where the patient suffers from chills and extreme shaking for about 1 to 2 hours
• Hot stage where the patient develops high fever of about 107°F (41.7°C) for 3-4 hours
• Wet stage is characterized by excessive sweating for 2 to 4 hours

Cerebral Malaria Treatment
If left untreated, cerebral malaria will lead to death of patient. There are two types of cerebral malaria treatment that help in saving the patient's life. These include antimalarial chemotherapy as adjunctive measure. In case of chemotherapy, the patients with severe cerebral malaria are administered with quinine. The use of this drug that has remained the most effective treatment for cerebral malaria for many years. Quinine affects the digestive ability of the parasite's enzymatic digestion causing its death.

Adjunctive measures include use of antipyretics like paracetamol to reduce fever. Anticonvulsants like phenobarbital sodium to reduce and prevent seizures. Osmotic diuretics are used to reduce the intracranial pressure and hypertonic glucose helps in hypoglycemia correction. Corticosteroids are used as anti-inflammatory medications. Other cerebral malaria treatment options include desferrioxamine, an iron chelating adjuvant that has antimalarial properties and pentoxifylline that helps in reduction of red blood cell deformability and blood viscosity.

Long Term Effects of Cerebral Malaria
If the patient does not receive immediate treatment, it can lead to long-term effects of cerebral malaria. These long-term effects of cerebral malaria in most patients include the following serious ailments like:

• Jaundice
• Uremia
• Tender and enlarged spleen
• Chronic renal failure
• Seizures
• Acute intracranial pressure
• Hemiplegia
• Delirium

There are many clinical manifestations of cerebral malaria. But of these many, three are very commonly seen in both children as well as adults. These include impaired consciousness with non-specific fever, generalized convulsions and coma for 24 to 72 hours. If you see a patient with high fever who refuses to eat or drink, take him over to a hospital immediately. Get the patient tested for malaria, especially if you live in a malaria prone region.