Walsh & Hoyt: Cerebral Malaria

Cerebral malaria is an acute, febrile, diffuse encephalopathy and may be the most common nontraumatic encephalopathy in the world. It occurs primarily in patients with infection by P. falciparum, arising in about 1% of such patients. Although tissue hypoxia associated with malaria caused by any of the other plasmodia species can produce cerebral ischemia, infarction, and neurologic dysfunction in patients with pre-existing cerebrovascular disease, this picture is not that of true cerebral malaria. Warrell et al. originally proposed a strict definition of cerebral malaria that was adopted by the World Health Organization in 1986. The criteria include documentation of parasitemia with P. falciparum, coma, and the exclusion of other causes of coma, such as hypoglycemia. To exclude postictal depression as the basis of coma, some investigators require that the diagnosis of cerebral malaria not be made in adults until they have had persistent coma for more than 24 hours after a seizure. In children, coma lasting 30 minutes to 2 hours after a seizure usually is considered sufficient to permit the diagnosis of cerebral malaria.