cerebral malaria diagnosis treatment

1. Cerebral Malaria
By
Dr Tanveer alam khan

2. Malaria Threatens
40% world population

3.  What is malaria?
 What is cerebral malaria?
 How malaria spreads?
 pathophysiology ?
 What are clinical features?
 Differential diagnosis?
 How to diagnose
 Management
 prognosis

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5.  Malaria is a disease of the blood that is caused by
the Plasmodium parasite, which is transmitted from
person to person by a particular type of mosquito
 female Anopheles mosquito is the only mosquito that
transmits malaria.
 She primarily bites between the hours of 9pm and
5am,

6.  A strict definition of cerebral malaria has been
recommended for sake of clarity
 “this requires the presence of unarousable coma,
exclusion of other encephalopathies and
confirmation of P. falciparum infection”
 This requires the presence of P. falciparum parasitemia and
the patient to be unrousable with a Glasgow Coma Scale
score of 9 or less, and other causes (e.g. hypoglycemia,
bacterial meningitis and viral encephalitis) ruled out. To
distinguish cerebral malaria from transient postictal coma,
unconsciousness should persist for at least 30 min after
aconvulsion.

7.  Mechanical hypothesis:
 Rostting/cytoadherence
 The basic underlying defect clogging of the cerebral micocirculation by the
parasitized red cells. These cells develop knobs on their surface and develop
increased cytoadherent properties, as a result of which they tend to adhere to
the endothelium of capillaries and venules.

9.  Earliest Manifestations –
 Fever
 Loss of Appetite
 Vomiting
 Cough
 Specific for Cerebral Malaria
Impaired consiousness
Gen. Convulsion with Sequelael
Coma > 30min

13.  Lumbar puncture
 Thick film
 Thin film
 Ict malaria
 PCR
 The malarial retinopathy
1)retinal whitening 2)vessel changes,
3)retinal hemorrhages 4) papilledema.
The first two of these abnormalities are specific to malaria, and are
not seen in other ocular or systemic conditions

14.  Maintain a clear airway. In cases of prolonged, deep coma, endotracheal
intubation may be indicated.
 Turn the patient every two hours.
 Avoid soiled and wet beds.
 Comatose patients should be placed in a semirecumbent position to reduce the
risk for aspiration.
 Naso-gastric aspiration to prevent aspiration pneumonia.
 Maintain strict intake/output record. Observe for high coloured or black urine.
 Monitor vital signs every 4-6 hours.
 Changes in levels of sensorium, occurrence of convulsions should also be
observed.
 If the temperature is above 390 C, tepid sponging and fanning must be done.
 Serum sodium concentration, arterial carbon dioxide tension, blood glucose,
and arterial lactate concentration should be monitored frequently.
 Urtheral cathetarization
 Seizures should be treated promptly with anticonvulsants, but their
prophylactic use is still in dispute.[1] Diazepam by slow intravenous injection,
(0.15 mg/kg, maximum of 10 mg)

15.  ACT (artesunate +amodiaquine or artemether-lumefantrine

18.  Cerebral malaria is a life threatening complication of malaria. It
affects
 children more than adult and should be considered in any
patient with
 impairment of consciousness. The mortality rate is high and a
 significant number of childhood survivors suffer from transient
 neurological deficit at discharge and subtle long-term cognitive
 deficiencies. High index of suspicision is needed for early
diagnosis and
 effective treatment. Urgent treatment with antimalarial drug is
required,
 but the prognosis often depends on the management of
complications.

19.  Cerebral Malaria is a fatal disease
 Strict criterion needs to be followed before
establishing diagnosis for cerebral malaria
 Hospital admission with ICU is required
 Cerebral malaria has poor prognosis