Cerebral malaria

Cerebral malaria is the most lethal form of Plasmodium falciparum infection. The disease is defined clinically as an otherwise unexplained coma in someone with malaria parasitemia. One in 6 children with cerebral malaria dies and many survivors are left with neurologic, cognitive, or behavioral sequelae. Acute seizures are common and increasing numbers of them during the index illness are associated with a greater likelihood of adverse outcomes. Optimal treatment pathways for children with cerebral malaria have been standardized but the search for an adjunctive therapy that decreases cerebral malaria mortality or morbidity has, so far, remained elusive. After hospital discharge, care gaps for survivors continue in the diagnosis and management of educational challenges, behavioral abnormalities, and epilepsy, especially in the rural settings where malaria incidence is highest. In the past decade, science has elucidated much about cerebral malaria pathogenesis. Observational studies using magnetic resonance imaging, electroencephalogram, and transcranial doppler have all provided insight on the pathway from the initial infection transmitted by a mosquito, to death. Findings from each of these high technology modalities are also associated with outcomes in children with cerebral malaria. We review the epidemiology, clinical features, diagnostic considerations, optimal clinical care pathways, neurological sequalae, and existing care gaps in the management of cerebral malaria and its complications.