Pathophysiology, clinical presentation and treatment of cerebral malaria

Infection with Plasmodium falciparum can cause severe disease in the non-immune individual. Cerebral malaria is in most cases just one of the organs affected by the disease. The direct cause of coma in cerebral malaria remains obscure. A compromised microcirculation, with sequestration of parasitized erythrocytes, is central in the pathogenesis. Intravenous artesunate is superior to quinine in the treatment of severe malaria, possibly because of its broader stage specificity, preventing young ring forms to mature and sequester. Intravenous artesunate should become the treatment of choice in adults, and possibly also in children. Since multi organ involvement is very common, supportive treatment is essential to improve survival in this disease, which is responsible for more than one million deaths per year. Neurology Asia 2005; 10 : 67 – 77 Address correspondence to: Dr AM Dondorp, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail: [email protected] INTRODUCTION Severe malaria is a potentially fatal disease. Rapid diagnosis and treatment is essential. It is a multi system disease, but cerebral malaria, characterized by unrousable coma, is one of the most common features. The direct cause of coma, which has a remarkable complete recovery in most of the surviving cases, is not known. This paper will review the pathophysiological and pathological changes associated with cerebral malaria, and the clinical presentation, diagnosis and treatment of this condition.