Case Report: A Case of Severe Cerebral Malaria Managed with Therapeutic Hypothermia and Other Modalities for Brain Edema

Abstract

Malarial infections are uncommon in the United States and almost all reported cases stem from recent travelers coming from endemic countries. Cerebral malaria (CM) is a severe form of the disease usually affecting children and individuals with limited immunity. Despite proper management, mortality from CM can reach up to 25%, especially when it is associated with brain edema. Inefficient management of the edema may result in brain herniation and death. Uniform guidelines for management of CM-associated brain edema are lacking. In this report, we present a case of CM with associated severe brain edema that was successfully managed using a unique combination of therapeutic hypothermia, hypertonic saline, mannitol, and hyperventilation along with the antimalarial drugs quinidine and doxycycline. Our use of hypothermia was based on its proven benefit for improving neurological outcomes in post-cardiac arrest patients and previous in vitro research, suggesting its potential inhibitory role on malaria growth.

Figure 1.

Peripheral blood smear showing classic rings of Plasmodium falciparum (arrow). This figure appears in color at www.ajtmh.org.

Figure 2.

Computed tomography scan of the head showing severe brain edema at presentation with loss of sulci/gyri differentiation (A) and the complete resolution of brain edema after treatment with restoration of normal radiologic brain anatomy (B). This figure appears in color at www.ajtmh.org.