Stroke incidence, presentation, and outcomes in malaria: a review of current evidence

Malaria, a global health challenge, remains a leading cause of morbidity and mortality, particularly in sub-Saharan Africa, Southeast Asia, and South America. While traditionally associated with fever and systemic complications, the neurological impact of malaria, including stroke, has become a significant concern. This review aims to examine the incidence, clinical presentation, and outcomes of stroke in individuals with malaria, highlighting the role of malaria in both ischaemic and haemorrhagic strokes. A literature search identified nine studies published between 1999 and 2024, comprising case reports and case series involving malaria-related strokes in patients aged 2 to 47 years. Most cases involved Plasmodium falciparum, with a notable association between this parasite and haemorrhagic strokes. Plasmodium vivax, while less commonly implicated, was associated with ischaemic strokes, especially in younger patients. Diagnostic challenges, including misdiagnosis, were frequently encountered due to the overlap of neurological symptoms with cerebral malaria, emphasizing the need for a high index of suspicion. The pathophysiology of malaria-related strokes is multifactorial, with both mechanical obstruction of cerebral vessels and hypercoagulable states contributing to stroke development. Treatment generally involves a combination of anti-malarial therapy and supportive care, including management of complications such as raised intracranial pressure or seizures. Outcomes vary, with ischaemic stroke patients showing better recovery than those with haemorrhagic strokes. However, mortality remains high, particularly in cases with severe complications like cerebral venous thrombosis. Early diagnosis and intervention are crucial for improving survival and minimizing long-term neurological impairment. Further research is needed to refine diagnostic approaches, elucidate the underlying mechanisms, and optimize management strategies for stroke in patients with malaria.