Adult Cerebral Malaria in a Malaria-Endemic Region in Sub-Saharan Africa: A Case Report

Abstract

Cerebral malaria (a subtype of severe malaria with cerebral involvement) is defined as an acute, non-traumatic encephalopathy, typically caused by Plasmodium species, particularly P. falciparum. It is characterised by multiple episodes of seizures and altered sensorium. It is rare for an adult permanently resident in a malaria-endemic region to develop severe malaria with cerebral involvement. We present a 31-year-old man, primarily resident in Southwest Nigeria, West Africa, who presented with fever, multiple episodes of seizures, and loss of consciousness. Signs of meningeal irritation were absent. He was euglycaemic at presentation (Random Blood Glucose = 96 mg/dL). Fundoscopy revealed bilateral retinal haemorrhages, retinal vessel colour changes, and papilloedema (worse in the left eye). Cerebrospinal fluid analysis findings were not consistent with meningitis. Neurological imaging was not performed due to paucity of funds. A diagnosis of cerebral malaria in an adult was made. He was commenced on intravenous artesunate. He regained full consciousness at about the 30th hour of admission and was observed on the ward for a further 72-hour period. He was discharged home on the fifth day of admission. There were no post-malaria neurological sequelae at discharge. He has been reviewed twice, 6 weeks apart, in the outpatient department, and the assessment on both occasions was clinically satisfactory.