Diagnosis and management of the neurological complications of falciparum malaria

Abstract

Malaria is a major public health problem in the developing world owing to its high rates of morbidity and mortality. Of all the malarial parasites that infect humans, Plasmodium falciparum is most commonly associated with neurological complications, which manifest as agitation, psychosis, seizures, impaired consciousness and coma (cerebral malaria). Cerebral malaria is the most severe neurological complication; the condition is associated with mortality of 15-20%, and a substantial proportion of individuals with this condition develop neurocognitive sequelae. In this Review, we describe the various neurological complications encountered in malaria, discuss the underlying pathogenesis, and outline current management strategies for these complications. Furthermore, we discuss the role of adjunctive therapies in improving outcome.

Figure 1

Malarial retinopathy. Photograph of the retina in patient with malaria, which shows exudates (arrowheads), hemorrhages (thick arrows) and changes in the color of the blood vessels (thin arrows). Permission obtained from Nick Beare, Royal Liverpool University Hospital, Liverpool, UK and Terri Taylor, Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi.

Figure 2

FLAIR images of the brain of a patient with cerebral malaria. a | Loss of sulci and narrowing of the ventricles (brain swelling), with hyperintensity in the semiovale centrum along with abnormal signal in the splenium of the corpus callosum (arrow). b | One week after the onset of illness, the image shows widening of the sulci and ventricles, with resolution of hyperintensities, except for the lesion in the splenium of the corpus callosum (arrow). Abbreviation: FLAIR, fluid-attentuated inversion recovery. Permission obtained from the American Society of Neuroradiology © Cordoliani Y. S. et al. AJNR Am. J. Neuroradiol. 19, 871–874 (1998).