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[Hyperkinetic shock and cerebral malaria].

J M Saissy1, R Gohard, O Raux

  • 1Service d'Anesthésie-Réanimation, Hôpital Principal, Dakar, Sénégal.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1990
PubMed
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Cerebral malaria can cause hyperkinetic shock, a rare condition. While one patient died despite intensive care, another recovered with fluid therapy and dopamine, highlighting varied responses to treatment.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Hematology

Background:

  • Cerebral malaria is a severe complication of Plasmodium falciparum infection.
  • Hyperkinetic shock is a rare but serious manifestation of severe malaria.
  • Understanding the pathophysiology of algid malaria is crucial for effective treatment.

Observation:

  • Two cases of cerebral malaria presenting with hyperkinetic shock are detailed.
  • Case 1: A 39-year-old European male presented with coma, jaundice, and profound hypotension (60 mmHg systolic).
  • Case 2: A 14-year-old Senegalese female presented similarly, with initial hyperdynamic hemodynamics (Cardiac Index 6.5 L/min/m²).

Findings:

  • Hemodynamic profiles in hyperkinetic shock varied, with differing cardiac indices and peripheral resistances.

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  • Despite aggressive management including vasoactive drugs, Case 1 was fatal.
  • Case 2 showed recovery with fluid resuscitation and dopamine, indicating potential for successful intervention.

    • Implications:

    • The pathophysiology of hyperkinetic shock in cerebral malaria remains poorly understood, possibly involving cytoadherence, immune dysregulation, or endotoxins.
    • These cases underscore the need for further research into the mechanisms and optimal management of algid malaria.
    • Early recognition and tailored hemodynamic support may improve outcomes in hyperkinetic shock associated with cerebral malaria.