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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Headache, Fatigue, Forgetfulness, Disequilibrium, Double Vision, Impaired Neurological Status. Malaria?

I am working on a patient that is a 66 year old male. He presents with headache, fatigue , forgetfulness, subtle behavior changes, disequilibrium, double vision and a wide-based gait. I know that it is an infectious disease , and I think it is possible that he may have malaria? Upon examination he presents normal however there is a slight impairment in his neurological status, any suggestions?
Fri, 11 May 2012
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Ophthalmologist,  's  Response
The findings that you mention suggest either:

Increased intracranial pressure -- if the diplopia is from an apparent bilateral or unilateral 6th nerve palsy with horizonal double vision.

Chronic Basilar meningitis which is picking off one or more cranial nerves. TB?

I would scan with contrast paying attention to the meninges.

If you don't think its infectious, also consider Wernicke's syndrome from thiamine deficiency.

I don't have any experience with Cerebral malaria, but understood it had a more encephalopathic picture due to its diffuse vasculitic nature.
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Headache, Fatigue, Forgetfulness, Disequilibrium, Double Vision, Impaired Neurological Status. Malaria?

The findings that you mention suggest either: Increased intracranial pressure -- if the diplopia is from an apparent bilateral or unilateral 6th nerve palsy with horizonal double vision. Chronic Basilar meningitis which is picking off one or more cranial nerves. TB? I would scan with contrast paying attention to the meninges. If you don t think its infectious, also consider Wernicke s syndrome from thiamine deficiency. I don t have any experience with Cerebral malaria, but understood it had a more encephalopathic picture due to its diffuse vasculitic nature.