Overview
Cerebral malaria (CM) is a severe neurological complication of Plasmodium falciparum infection, characterized by coma and seizures, often leading to multiorgan dysfunction syndrome (MODS) and high mortality rates, particularly in pediatric populations 14.Diagnosis
Clinical Presentation: Coma, seizures, altered sensorium 12.
Laboratory Tests: Peripheral blood smear confirming P. falciparum parasitemia 1.
Imaging:
- CT brain may be normal initially; MRI can reveal deep gray and white matter involvement, diffusion restriction, and hemorrhagic transformation 2.
Organ Dysfunction Scoring: Use of PELOD-2, pSOFA, SICK, and LODS scores to assess MODS 45.Management
First-Line Treatment: Intravenous antimalarial therapy, typically artesunate 1.
Supportive Care:
- Management of seizures with anticonvulsants 1.
- Fluid and electrolyte balance, mechanical ventilation if respiratory failure occurs 14.
- Monitoring and support for cardiac, renal, and hepatic functions 14.
Adjunctive Therapies: No specific adjunctive therapy demonstrated survival benefit in clinical trials 1.Special Populations
Pediatrics: High mortality rates, frequent MODS involving multiple organs (neurologic, hematologic, renal, hepatic) 145.
Comorbidities: Presence of conditions like hypertension and hypothyroidism may complicate presentation and prognosis 2.Key Recommendations
Assess and Monitor MODS: Utilize scoring systems like PELOD-2 and pSOFA to evaluate and manage multiple organ dysfunction in pediatric CM patients (Evidence: Moderate) 45.
Early Antimalarial Therapy: Initiate intravenous artesunate promptly for treatment of CM (Evidence: Strong) 1.
Supportive Care Focus: Prioritize supportive measures addressing neurologic, respiratory, cardiac, and renal dysfunctions (Evidence: Moderate) 14.
Consider Advanced Imaging: In cases where CT findings are inconclusive, MRI can provide critical insights into disease severity and prognosis (Evidence: Moderate) 2.References
1 Wynkoop HJ, Bvalani-Kaunda R, Seydel KB, Moxon CA, Chimalizeni Y, Taylor TE et al.. Cause-specific mortality in a cohort of paediatric cerebral malaria patients. Malaria journal 2025. link
2 Nayak B, Mohanty S, Das S, Panda S, Mishra SB. Radiological findings in fulminant cerebral malaria: a rare neuroimaging presentation. Malaria journal 2025. link
3 Nguyen B, Marshall JL, Rana C, Atem FD, Stutzman SE, Olson DM et al.. Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite. BMJ open 2024. link
4 Wynkoop HJ, Bevan A, Galeano X, Raees M, Haque MR, Taylor T et al.. Multiple Organ Dysfunction Syndrome in Malawian Children with Cerebral Malaria. The American journal of tropical medicine and hygiene 2024. link
5 Johnson H, Raees M, Urbina E, Muszynski J, Seydel K, Taylor T et al.. Multiple Organ Dysfunction Syndrome and Pediatric Logistic Organ Dysfunction-2 Score in Pediatric Cerebral Malaria. The American journal of tropical medicine and hygiene 2022. link