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Cerebral malaria comprises the clinical reflections of a Plasmodium falciparum infection, which causes neurological disorders such as nystagmus, conjugate gaze palsy, opisthotonus, seizures, and sometimes coma. It is a severe disease that causes ring-like lesions in the brain, and is accompanied by fever. The histopathological trademark of this disorder is the engorgement of cerebral capillaries and venules due to the accumulation of parasitized red blood cells (PRBCs) and non-parasitized red blood cells (NPRBCs). The patient should be treated as early as possible, as cerebral malaria becomes fatal within 24 - 72 hours. It is characterized by retinal whitening, which helps in distinguishing it from other causes of fever. The at-risk population primarily includes children below 10 years of age; especially those living in malaria-endemic areas.

Symptoms
Cerebral malaria is the most serious and life-threatening forms of malaria. This infection causes chills, persistent high fever, headache, orthostatic hypotension, myalgia, and red blood cell (RBC) sludging that leads to capillary blockage at several sites. The three initial stages are:
  • Cold Stage: It ranges from chills to extreme shaking for 1 - 2 hours.
  • Hot Stage: It is characterized by a high fever up to 107°F (41.7°C) for 3 - 4 hours.
  • Wet Stage: It is characterized by profuse sweating for 2 - 4 hours.
There are a few primary symptoms which are common in both, adults and children: impaired consciousness with non-specific fever, generalized convulsions, neurological abnormalities, and coma that lasts for 24 - 72 hours, initially rousable and then unrousable. If not treated on time, it can lead to complications like jaundice, hemoglobinuria, tender and enlarged spleen, acute renal failure, and uremia, and is fatal in about 20% of patients. Furthermore, it may manifest with signs of increased intracranial pressure, hemiplegia, encephalopathy, delirium, seizures, and coma.

Treatment
Since cerebral malaria gets fatal within a few days of infection, immediate treatment is necessary. The natural immunity to this disease is not very clear, but it can be artificially controlled by preventive strategies like antimalarial chemotherapy and adjunctive measures.
  • Chemotherapy for cerebral malaria mainly involves the use of quinine (a bitter alkaloid extracted from the Cinchona tree bark), in case the patient exhibits chloroquine resistance. It is the only drug which has remained highly effective over a long period of time for treating this disease. Quinine functions similar to chloroquine, and interferes with the parasite's enzymatic digestion.
  • Artemisinin, a clinically approved drug, is known to cure fever and parasitemia, faster than chloroquine or quinine. Commonly used by the Chinese as a traditional treatment for fever and malaria, it is a sesquiterpene lactone isolated from the plant Artemisia annua. It is commonly used as artesunate and artemether, and is an important factor in the treatment of multi-drug resistant P. Falciparum malaria. It is cheap and effective, but not yet licensed for use in Europe, North America, and Australia.
The use and efficacy of adjunctive measures are debatable. Some of the measures are as follows:
  1. Antipyretics, such as paracetamol, help in reducing fever. But how this diminution in the core temperature benefits the cerebral consequences is not yet clear.
  2. Pentoxifylline reduces the red blood cell deformation and blood viscosity. It impairs platelet aggregation and minimizes systemic vascular resistance, and hence improves microcirculatory flow.
  3. Anticonvulsants such as phenobarbital sodium are used for seizures. It is necessary to control seizures, as they cause neuronal damage and are linked with fatal outcomes.
  4. Desferrioxamine is an iron chelating adjuvant agent with antimalarial properties. It minimizes the formation of reactive oxygen species by decreasing the amount of free iron.
Cerebral malaria is a dangerous disease, and fatal in many cases. According to the World Health Organization (WHO), it affects nearly 300 - 500 million people every year, causing over one million deaths, and hence, possesses a very high mortality ratio as compared to other forms of malarial infections.

Disclaimer: This Buzzle article is for informative purposes only, and should not be used as a replacement for expert medical advice.