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Published on: January 2, 2013
Neurological sequelae of cerebral malaria in children
D R Brewster1, D Kwiatkowski, N J White
1Royal Victoria Hospital, Banjul, The Gambia.
Insights
Cerebral malaria in Gambian children caused significant mortality and long-term neurological deficits. Over half of survivors recovered fully, but a quarter experienced major neurological handicaps, highlighting the disease
Area of Science:
- Tropical Medicine
- Pediatric Neurology
- Infectious Diseases
Background:
- Falciparum malaria is a major cause of childhood illness in tropical regions.
- Cerebral malaria, a severe form, presents significant risks to children.
- Neurological sequelae can result from severe malaria infections.
Purpose of the Study:
- To investigate the outcomes of childhood falciparum malaria, focusing on cerebral malaria.
- To determine the mortality rates and neurological deficits associated with cerebral malaria.
- To identify factors contributing to sequelae and long-term recovery in affected children.
Main Methods:
- Retrospective analysis of 604 Gambian children admitted with falciparum malaria.
- Categorization based on cerebral malaria, severe anemia, and suspected cerebral malaria with negative blood films.
- Assessment of mortality, neurological deficits, and sequelae at admission and follow-up (1-6 months).
Main Results:
- 14% of children with cerebral malaria died; 7.8% with severe anemia died.
- 12% of cerebral malaria survivors had residual neurological deficits.
- Common sequelae included hemiplegia, cortical blindness, aphasia, and ataxia; prolonged coma and convulsions were predisposing factors.
Conclusions:
- Childhood cerebral malaria is a significant cause of neurological handicap in tropical areas.
- A substantial proportion of survivors experience long-term neurological deficits.
- Prompt recognition and management are crucial to mitigate severe outcomes and sequelae.
Abstract:
Out of 604 Gambian children admitted with falciparum malaria to one hospital between September and December, 1988, 308 had cerebral malaria and 203 were severely anaemic (haemoglobin less than 60 g/l). 14% of those with cerebral malaria died, as did 7.8% of those with severe anaemia. 32 (12%) of children surviving cerebral malaria had residual neurological deficit. 69 other children were admitted with clinical features strongly suggestive of cerebral malaria but with negative blood films; 16 of these died and 3 had residual neurological deficits. The commonest sequelae of cerebral malaria were hemiplegia (23 cases), cortical blindness (11), aphasia (9), and ataxia (6). Factors predisposing to sequelae included prolonged coma, protracted convulsions, severe anaemia, and a biphasic clinical course characterised by recovery of consciousness followed by recurrent convulsions and coma. At follow up 1-6 months later over half these children had made a full recovery, but a quarter were left with a major residual neurological deficit. Cerebral malaria in childhood may be an important cause of neurological handicap in the tropics.
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