Malaria and the nervous system

The neurological complications of malaria--an almost universal problem although it occurs mainly in the tropics--constitute the commonest cause of death and morbidity. These complications usually occur in P. falciparum infections and in those who are non-immune, such as children, pregnant women and visitors to areas endemic for malaria. They are rare in children suffering from protein-calorie malnutrition. Febrile convulsions, the commonest childhood emergency in the African and cerebral malaria are the commonest neurological complications. Spinal cord disorders and polyneuropathy have been described but are rare. It has been suggested that various forms of mental illness and psychoses may be related to malarial infections, but much research is needed to establish cause and effect relationship. The neuropathology and pathogenesis, clinical presentations, treatment and mortality of the neurological complications are reviewed.