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Neurological manifestations of malaria : an update
1Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
Insights
Severe falciparum malaria causes neurological complications, particularly in children, with high mortality and lasting sequelae. Survivors may develop post-malaria neurological syndromes, including ataxia and convulsions, highlighting the need for better management.
Area of Science:
- Neurology
- Infectious Diseases
- Tropical Medicine
Background:
- Falciparum malaria, a severe infectious disease, is linked to numerous neurological complications.
- Cerebral malaria is a particularly feared complication, disproportionately affecting children.
- Despite advances in antimalarial drugs, mortality rates remain high, and survivors often face disabling neurological sequelae.
Purpose of the Study:
- To review the spectrum of neurological complications associated with falciparum malaria.
- To differentiate malaria-related neurological issues from other conditions in pediatric patients.
- To highlight the persistent challenges in managing severe malaria and its neurological aftermath.
Main Methods:
- Literature review of neurological complications in falciparum malaria.
- Analysis of case reports and clinical descriptions of neurological syndromes.
- Discussion of diagnostic challenges, particularly differentiating malaria-induced convulsions from febrile convulsions.
Main Results:
- Cerebral malaria is a major cause of neurological morbidity and mortality in children.
- Survivors frequently experience neurological sequelae, including post-malaria neurological syndrome (PMNS).
- Various syndromes like cerebellar ataxia, psychiatric disorders, peripheral neuropathies, and stroke-like episodes have been reported, though their direct association with malaria is sometimes uncertain.
Conclusions:
- Neurological complications significantly impact falciparum malaria outcomes, necessitating improved treatment and supportive care.
- Early recognition and differentiation of malaria-associated neurological disorders are crucial for effective management.
- Further research is needed to clarify the pathophysiology and establish definitive links for less common neurological manifestations.
Abstract:
Several neurological complications are associated with complicated and severe falciparum malaria. Cerebral malaria is one of the most dreaded complication. The children are particularly more vulnerable to have this complication. Despite availability of several potent antimalarial drugs in recent past, the mortality status has not changed. A large number of survivors are left with disabling neurological sequelae. Few patients may experience post-malaria neurological syndrome after recovery from complicated falciparum infection. Various psychiatric syndromes have been described either as early manifestation of cerebral malaria or part of post malaria neurological syndrome. From Indian subcontinent several patients of delayed cerebellar ataxia have also been described following recovery from clinical malaria. In paediatric patients, convulsions of cerebral malaria need to be differentiated from febrile convulsions. Falciparum malaria is also associated specifically with convulsions in uncomplicated patients of malaria. Several isolated case reports of various other neurological syndromes like peripheral neuropathies, various movement disorders, myelopathies and stroke like syndrome have been described. However association of these neurological manifestations with malaria remains doubtful.