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Neurological features of cerebral malaria in Nigerian children
P E Olumese1, R A Gbadegesin, A A Adeyemo
1Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria. p.olumese@skannet.com
Insights
Cerebral malaria in young children often presents with non-specific neurological signs like seizures and abnormal tone. Specific neurological findings, such as coma depth and absent corneal reflexes, are key indicators of poor prognosis in these cases.
Area of Science:
- Neurology
- Pediatrics
- Tropical Medicine
Background:
- Cerebral malaria is a frequent cause of acute neurological illness in malaria-endemic regions.
- Detailed clinical neurological findings for cerebral malaria are infrequently reported.
- High malaria transmission areas necessitate understanding pediatric neurological syndromes.
Purpose of the Study:
- To document neurological features of cerebral malaria in young children.
- To correlate these neurological findings with patient prognosis.
- To emphasize the importance of clinical examination in diagnosing and predicting outcomes.
Main Methods:
- A study was conducted on 103 children aged 5 years or less with cerebral malaria in Ibadan, Nigeria.
- Clinical neurological examinations were performed to identify specific signs and symptoms.
- Prognostic indicators were analyzed in relation to observed neurological features.
Main Results:
- Convulsions (87%), abnormal posture (41%), abnormal tone (70%), and abnormal deep tendon reflexes (74%) were common.
- Absent corneal reflexes were noted in approximately 14% of subjects.
- Poor prognostic indicators included time to hospital, decerebrate/decorticate posturing, absent corneal reflexes, and coma depth/duration.
Conclusions:
- Cerebral malaria in children often manifests with diffuse, symmetrical upper motor neuron dysfunction.
- Specific neurological signs are associated with poor prognosis, aiding in early risk assessment.
- Considering cerebral malaria in children with acute encephalopathy in endemic areas and performing thorough clinical evaluations are crucial.
Abstract:
Cerebral malaria is one of the commonest causes of an acute neurological syndrome in malaria-endemic areas. However, there are few detailed reports of findings on clinical neurological examination of the condition. The neurological features of cerebral malaria in 103 children aged 5 years or less were studied in Ibadan, Nigeria, an area of high malaria transmission. The correlation of these features with prognosis was also studied. Convulsions occurred in 87% of subjects and were in most cases of a generalized tonic-clinic nature. Abnormalities of posture were observed in 41%, abnormal tone in 70% and abnormal deep tendon reflexes in 74%. Absent corneal reflexes were found in about 14%. The time interval between the last seizure episode and presentation in hospital, abnormal posture (decerebrate or decorticate), absence of corneal reflex and depth and duration of coma were indicators of poor prognosis. In this study, cerebral malaria presented with non-specific features of diffuse, symmetrical, upper motor neurone dysfunction, and some specific neurological features were associated with poor prognosis. It is important that cerebral malaria be considered in any child with features of acute encephalopathy in a malaria-endemic area. Careful clinical examination of such children is essential as neurological features of the condition may provide a clue to prognosis.