Spontaneous chronic subdural hematoma following Plasmodium vivax malaria: a rare association.

Chronic subdural hematoma (traumatic or spontaneous) is one of the commonly encountered neurosurgical emergencies. However, development of the same following malaria is an uncommon event. Spontaneous subdural hematoma following Plasmodium falciparum malaria has been reported in literature1–2. But, to date, no case of P. vivax associated with chronic subdural hematoma has been reported. We herein report a 45-yr old male patient who developed spontaneous chronic subdural hematoma following P. vivax malaria. A 45-yr old male presented to us with complaints of gradual reduction in level of consciousness, headache and weakness of left upper and lower limbs over 20 days duration. He had history of fever with chills and rigors for which he got treated in a tertiary care centre in northeastern part of India, endemic for malaria, approximately one month back. During his hospital stay he developed severe headache which gradually worsened and was associated with excessive drowsiness and weakness of left upper and lower limbs. On investigation he was found to be positive for P. vivax by OptiMAL test, [a rapid, 20-min malaria detection test utilizing a dipstick coated with monoclonal antibodies against the intracellular metabolic enzyme parasite lactate dehydrogenase (pLDH), Diamed, Cressier, Switzerland]. He was treated with artemether (dosages not known) for about 10 days and gradually improved to become apyrexic. However, he developed headache and gradually progressive weakness. About 20 days following discharge he was brought to our emergency department in altered sensorium and glasgow coma scale (GCS) score of E2M5V1 (8/15) with recurrence of fever. Pupils were unequal and not reacting to light and fundi showed bilateral papilledema. His reflexes were brisk with bilaterally upgoing plantars. There were no signs of meningeal irritation. NCCT scan of brain showed bilateral chronic subdural hematoma (left > right) with mass effect and midline shift of 5 mm towards the right side. His coagulation profile was normal [platelet count: 2.6 lakhs/mm3, bleeding time: 3 min and clotting time: 5 min, prothrombin time: 12 sec (control: 13 sec), and activated partial thromboplastin time: 34 sec (conJ Vector Borne Dis 51, March 2014, pp. 73–74