Cerebral malaria

This brain has got cerebral malaria from being stung in the brain.

Definition

Malaria affecting the cerebrum.

Epidemiology

Clinical Features

• Flu-like prodrome: headache, malaise, muscle aches, anorexia followed by periodic fever; anaemia, jaundice and hepatosplenomegaly.
• Cerebral malaria specifically: confusion, coma +/- seizure. Possibly the following: tone variation, extensor posturing, upgoing plantars, dysconjugate gaze, teeth-grindingg.

Investigations

Using serial thick & thin blood films and you should get a parasite count as well. FBC, glucose (for hypoglycaemia), blood gases, U+E, urinalysis and blood culture.

Management

Artesunate or quinine 20mg salt/kg over 4h. After 8h, give 10mg/kg (max 700mg) iv until patient can swallow. Monitor blood glucose.