Cerebral malaria is an rapidly progressive, acute, potentially fatal widespread disease of the brain which is accompanied by fever and involves the clinical manifestations of Plasmodium falciparum malaria that induce changes in mental status and coma along with fever, chills, headache, vomiting and profuse sweating

 

Causes:

• Plasmodium falciparum a parasite is the main cause
• Malarial toxin stimulates production of TNF and cytokines that induce endothelial cells to produce nitric oxide in an uncontrolled manner that diffuse through blood brain barrier and cause coma
• Endothelial cyto adherence and rosetting of ligands like ICAM-I and E resulting in reduction of microvascular blood flow resulting in Hypoxia and coma
• Improper or negligency in treatment of malaria in initial stages
• Unhygienic conditions, poor sanitation and long standing water drains or open fields can be a cause

Symptoms:

• High non specific fever with chills and rigors
• Impaired consciousness and coma
• Generalised seizures and neurological sequelae
• Fatigue, vomiting, malaise, sweating are the other symptoms

Complications:

• Hypoglycemia
• Hypovolemia
• Hyperpyrexia
• Renal failure
• Bleeding disorders and anemia
• Lactic acidosis and pulmonary edema
• Death can occur in fatal and untreated conditions

Diagnosis:

• History from the relatives including treatment, drugs taken and previous hospitalization and physical examination
• Complete blood count and Electrolytes
• Fluorescence microscopy: nucleic acid of parasites or nucleated RBC can be found
• Serological tests for antigen and antibody detection of the parasites
• Biochemical tests for LDH left by parasites
• PCR and blood culture
• Lumbar puncture, CT scan, MRI for eliminating other causes and also for involvement of the disease

Treatment:

• Chemotherapy primarily involves the use of quinine and chloroquine
• Artemisinins clear parasitemia and fever faster than quinine or chloroquine
• The two most widely used anti malarial drugs are artesunate and artemether

Supportive Treatment:

• Anti-pyretics: Paracetamol to reduce fever
• Anti-convulsants: Phenobarbital sodium for seizures.
• Osmotic diuretics are used to reduce intracranial pressure  
• Hypoglycemia correction using hypertonic glucose
• Exchange transfusion generally when peripheral parasitemia exceeds 10% of circulating erythrocytes
• Anti-Inflammatories: Corticosteroids
• Desferrioxamine: An iron-chelating adjuvant agent with anti malarial properties reduces formation of reactive oxygen species by reducing amount of free iron.
• Microcirculatory Flow ­Pentoxifylline reduces red cell deformability and blood viscosity, decreases systemic vascular resistance, and impairs platelet aggregation, thus improving microcirculatory flow.