Cerebral Malaria and Its Neurological Consequences

Cerebral Malaria: Symptoms, Brain Impact & Recovery Options

One of the most severe forms of malaria that causes neurological complications is known as cerebral malaria. It affects children under the age of 5 and it can also affect non-immune adults. The primary cause of cerebral malaria is Plasmodium falciparum infection.

Cerebral malaria has a high mortality rate, and patients who survive experience long-term neurocognitive disability. Researchers are still working to understand how an intravascular parasite can cause such kinds of brain issues.

How is Cerebral Malaria Different From Normal Malaria?

Malaria occurs when a mosquito infected with the Plasmodium parasite bites and transmits the parasite into the bloodstream of a person. The severity of this disease depends on the location and the status of the immune system of the patient.

Cerebral malaria is a life-threatening form of malaria that causes a patient to suffer from neurological disorders like epilepsy, behavioural difficulties, and cognitive deficits. About 2% of malaria patients are affected by cerebral malaria.

What are the symptoms of cerebral malaria?

The symptoms of cerebral malaria include:

1. Coma
2. Disconjugate gaze or strabismus
3. The ocular deviation is mostly lateral or upward.
4. Neck rigidity
5. Seizures
6. Abnormal posture
7. Nystagmus or dancing eyes
8. Electroencephalographic abnormalities, abnormal brain function
    

Which organ is affected by cerebral malaria?

Cerebral malaria primarily affects the brain. Impaired consciousness with coma is the most severe manifestation of cerebral malaria. The parasite-filled red blood cells cause blockage in small blood vessels, which leads to potential brain damage. Eventually, this results in coma, seizures and even death.

Besides impaired consciousness, cerebral malaria also leads to brain swelling, retinal changes, anaemia, shock, hypoglycaemia, and electrolyte imbalance.

How is Cerebral Malaria Diagnosed?

The World Health Organisation Malaria Action Programme has stated three criteria to diagnose cerebral malaria:

1. Unarousable coma, where the patient is unable to wake even with the presence of strong stimuli.
2. Exclusions of other encephalopathies indicate the elimination of other conditions that might cause brain dysfunction.
3. Confirmed presence of Plasmodium falciparum infection.
4. The presence of malignant retinopathy (retinal hemorrhages, whitening, vessel discoloration) on fundoscopic examination is a highly specific clinical sign that strongly supports the diagnosis of cerebral malaria.
    

What are the complications of cerebral malaria?

Malignant retinopathy is one of the most serious complications of cerebral malaria. When this complication arises due to cerebral sequestration of Plasmodium falciparum, it affects the retina of the patient. The following symptoms help to diagnose the condition:

1. Retinal whitening
2. Papilloedema
3. Retinal haemorrhages
4. Severe anemia
5. Hypoglycemia
6. Metabolic acidosis and acute kidney injury
7. Respiratory distress
    

What is the Best Treatment for Cerebral Malaria?

The best treatment for cerebral malaria includes:

1. Intravenous Artesunate: Patients suffering from a severe form of cerebral malaria require instant intravenous artesunate. These are antimalarials, and a single dose can save a patient's life.
2. Antimalarial Medicines Derived from Cinchonoids: Medicines derived from cinchonoids (like quinine) or artemisinin target various mechanisms within the malaria parasite. It disrupts the life cycle of the parasite, Plasmodium falciparum.

Can You Fully Recover from Cerebral Malaria?

If patients with cerebral malaria receive proper treatment on time, they can be cured. However, some patients experience long-term neurological deficits. Most of the treatment methods for cerebral malaria focus on managing complications and eliminating the parasite.

What are the ways to prevent cerebral malaria?

Since cerebral malaria is the most severe form of malaria, reducing mosquito bites and using antimalarial medications can prevent it.

The World Health Organisation recommends that people living in malaria-prone zones use mosquito nets and repellents. The repellents, consisting of DEET and icaridin, are the most effective. In addition, wearing protective clothing, vector control through insecticides, using window screens, and keeping the surrounding areas clean are some of the best malaria preventative measures.

Cerebral malaria is not a discrete or single syndrome. The symptoms and progression of coma follow multiple mechanisms in every patient. To rehabilitate patients, doctors follow strategies such as cognitive exercises, speech therapy and physical therapy. While many patients survive with prompt treatment, recovery can be prolonged. A significant number of survivors, particularly children, experience long-term neurological deficits such as cognitive impairment, epilepsy, and motor disabilities, highlighting the need for ongoing neurological follow-up and rehabilitation.