Cerebral malaria presenting as nonconvulsive status epilepticus: a case report

Area of Science:

• Neurology
• Infectious Diseases
• Clinical Medicine

Background:

• Malaria, caused by Plasmodium parasites, can lead to severe complications like cerebral malaria.
• Cerebral malaria typically presents with fever, altered consciousness, and seizures.
• Nonconvulsive status epilepticus is an exceptionally rare manifestation of cerebral malaria.

Observation:

• A 53-year-old male with a travel history to Tanzania presented with confusion and abnormal behavior.
• Initial blood smears were negative for Plasmodium, but metagenomic sequencing of cerebrospinal fluid detected P. falciparum DNA.
• Continuous electroencephalogram monitoring confirmed nonconvulsive status epilepticus.

Findings:

• The patient was diagnosed with cerebral malaria presenting as nonconvulsive status epilepticus.
• Treatment with anti-malarial drugs, diazepam, and levetiracetam led to full recovery.
• Brain MRI showed no significant abnormalities, underscoring the diagnostic challenge.

Implications:

• This case underscores that nonconvulsive status epilepticus can be a presenting symptom of cerebral malaria.
• Physicians should maintain a high index of suspicion for cerebral malaria in patients with relevant travel history or prior infection, especially with atypical neurological symptoms.
• Early diagnosis and prompt treatment are crucial for favorable outcomes in cerebral malaria with unusual presentations.