Case Report: Reversible Cerebral Vasoconstriction Syndrome in Cerebral Malaria

Abstract

Cerebral malaria is a severe complication of falciparum malaria that occurs infrequently in adults. Here, we describe the case of a 21-year-old man who presented with fever and headache 13 days after returning from a 12-day trip to Kenya and was subsequently diagnosed with falciparum malaria. Complications of cerebral malaria developed within 1 day after the initiation of therapy with intravenous quinine, and the patient entered a deep coma. Magnetic resonance angiography (MRA) revealed multiple vasoconstrictions in his brain. The resulting neurocognitive disorders that persisted after parasite clearance improved gradually, as confirmed by MRA, enabling the patient to perform activities of daily living upon discharge. In this case of cerebral malaria, the MRA findings indicated the involvement of reversible cerebral vasoconstriction syndrome.

Figure 1.

Brain magnetic resonance imaging (fluid attenuation inversion recovery) and magnetic resonance angiography (MRA) findings. Brain MRA (time-of-flight angiography) findings on the 6th day of illness (A) reveal the narrowing of multiple cerebral arteries, indicated by a white arrowhead. On day 40 of illness (B), the arterial narrowing had improved, but diffuse cerebral atrophy had mildly progressed. (a) Right anterior communicating artery; (b) right internal carotid artery; (c) left anterior communicating artery; and (d) left internal carotid artery.