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What is cerebral malaria?

Cerebral malaria (CM), a severe complication of malaria, is a neurological syndrome characterised by seizures and coma. It is mainly observed in young children and adults residing in malaria-prone areas.

What are its main signs and symptoms?

CM can develop in less than 2 weeks after a mosquito bite and beyond 2 to 7 days of fever. It is characterised by abnormal behaviour,impaired consciousness, epileptic fits, coma and other neurological symptoms. It is found that 6 out of 14 children show increased cerebral volume. CM can also cause defects in movements, speech difficulties, deafness and blindness in children. Signs and symptoms include:

Neurological features are often associated with severe metabolic acidosis (too much acid in body fluids), low haemoglobin and reduced sugar level.

What are its main causes?

It spreads through the bite of the female Anopheles mosquito. There are four species of Plasmodium responsible for the infection, out of which P. falciparum is the most severe infection. CM occurs due to blockage of the small capillaries of the brain by infected blood cells, resulting in swelling of the brain and eventually brain damage. The blood-brain barrier (BBB), which protects the brain from foreign substances, gets ruptured and fibrinogen leakage is observed. This can result in coma. Other reasons for neurological complications may include:

  • High-grade fever
  • Anti-malarial medicines
  • Reduced sugar levels
  • Reduced sodium levels
  • Extremely low haemoglobin levels

How is it diagnosed and treated?

Doctors take a medical history including any recent travel history to malaria-prone areas and do a physical examination. Imaging may be done to find ischaemia-involved areas.

  • Computed tomography (CT) scan: It may appear normal, but some features can be seen, such as
  1. Cerebral oedema
  2. Thalamic hypoattenuation due to infarcts
  3. Cerebellar white matter hypoattenuation
  • Magnetic resonance imaging (MRI): Useful to understand the key presentations associated with disease progression.
  • Lumbar puncture: To exclude other causes of febrile syndromes with altered level of consciousness.

CM is a serious complication and requires immediate medical attention. Treatment mainly includes:

  • Anti-malarial drugs – monotherapy or combination therapy to avoid resistance.
  • Agents to correct electrolyte imbalance.
  • Symptomatic use of anti-epileptic drugs.
  • Steroid derivatives.
  • Correcting other neurological complications.
  • Oxygen therapy may help in case of respiratory distress.

Self-care tips include:

  • Early identification of symptoms can help break the infection cycle.
  • Avoid unnecessary use of fever medications if it does not help in reducing prolonged fever.
  • Keep your surroundings clean and eliminate mosquito breeding sources.

Proper treatment and care can help in minimising brain damage and the complications of malaria.

  1. Medicines for Cerebral Malaria

Medicines for Cerebral Malaria

Medicines listed below are available for Cerebral Malaria. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Medicine NamePack SizePrice (Rs.)
Quinoquin EcQuinoquin Ec 300 Mg Tablet47
Quinoquin P EcQuinoquin P Ec Tablet24
Quinoquin PQuinoquin P Tablet24
QuinsulQuinsul 300 Mg Tablet30
QutisQutis 150 Mg Suspension42
QutomalQutomal 300 Mg Injection13
QutroyQutroy 300 Mg Injection14
SafequinSafequin 300 Mg Tablet52
SulfaquinSulfaquin 100 Mg Tablet42
Tq NinTq Nin 100 Mg Suspension43
Uniquin EcUniquin Ec 300 Mg Tablet60
ZequinZequin 300 Mg Tablet316
Arm QArm Q Injection22
MosgardMosgard 300 Mg Tablet0
Q MalQ Mal 300 Mg Tablet51
Q SQ S 300 Mg Tablet40
QuinaxQuinax 300 Mg Tablet559
QuinonirQuinonir Syrup23
QunimaxQunimax 300 Mg Tablet26
RadiantRadiant Syrup52
RubiquinRubiquin 300 Mg Tablet49
Rubiquin EcRubiquin Ec 450 Mg Tablet69
SulphaquinSulphaquin Suspension37
SwiquinSwiquin 300 Mg Tablet29
Rez Q DRez Q D 600 Mg/100 Mg Tablet178

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References

  1. Laurent Rénia et al. Cerebral malaria. Virulence. 2012 Mar 1; 3(2): 193–201. PMID: 22460644
  2. Anupkumar R. Anvikar et al. Epidemiology of Plasmodium vivax Malaria in India. Am J Trop Med Hyg. 2016 Dec 28; 95(6 Suppl): 108–120. PMID: 27708188
  3. Kumar A, Valecha N, Jain T, et al. Burden of Malaria in India: Retrospective and Prospective View. American Society of Tropical Medicine and Hygiene; 2007 Dec.
  4. Henry J. Shikani et al. Cerebral Malaria. Am J Pathol. 2012 Nov; 181(5): 1484–1492. PMID: 23021981
  5. Richard Idro et al. Cerebral Malaria; Mechanisms Of Brain Injury And Strategies For Improved Neuro-Cognitive Outcome. Pediatr Res. 2010 Oct; 68(4): 267–274. PMID: 20606600
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