Cerebral Malaria
Cerebral malaria is a life-threatening complication of Plasmodium falciparum infection, characterized by encephalopathy and a high risk of permanent neurological deficit or mortality.
1. Diagnostic Criteria
- Presence of P. falciparum: Confirmed by blood smear or rapid diagnostic test.
- Coma: Defined as a Glasgow Coma Scale (GCS) score ≤ 11 or Blantyre Coma Score ≤ 2, persisting for >1 hour after a seizure or correction of hypoglycemia.
- Exclusion: Absence of other causes of encephalopathy (e.g., bacterial meningitis, metabolic disturbances).
2. Clinical Features
| Clinical Sign | High-Yield Note |
|---|---|
| Neurological | Altered consciousness, seizures, and focal neurological deficits. |
| Systemic | Fever, anemia, jaundice, hypoglycemia, metabolic acidosis. |
3. Management Pearls
- First-line Therapy: Parenteral Artesunate is the treatment of choice.
- Supportive Care: Management of seizures (e.g., benzodiazepines), airway protection, and glucose monitoring.
- Avoid: Corticosteroids; they are contraindicated as they do not reduce mortality and may increase duration of coma.
NEET PG Hint: Remember the hallmark of severe malaria is sequestration of parasitized red blood cells in the microvasculature. In cases of coma in a malaria-endemic region, always rule out hypoglycemia before assuming malaria is the sole cause of the coma.