Neurological manifestations of malaria

Manifestações neurológicas da malária

Gustavo C. Román^I; Nimal Senanayake^II

^IM.D., F.A.C.P., Chief, Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, USA

^IIM.D., F.R.C.P., Professor of Medicine, Department of Medicine, Faculty of Medicine, University of Peradeniya, Paradeniya, Sri Lanka, and Visiting Scientist Neuroepidemiology Branch, NINDS, NIH, Bethesda, USA

SUMMARY

The involvement of the nervous system in malaria is reviewed in this paper. Cerebral malaria, the acute encephalopathy which complicates exclusively the infection by Plasmodium falciparum commonly affects children and adolescents in hyperendemic areas. Plugging of cerebral capillaries and venules by clumped, parasitized red cells causing sludging in the capillary circulation is one hypothesis to explain its pathogenesis. The other is a humoral hypothesis which proposes nonspecific, immune-mediated, inflammatory responses with release of vasoactive substances capable of producing endothelial damage and alterations of permeability. Cerebral malaria has a mortality rate up to 50%, and also a considerable longterm morbidity, particularly in children. Hypoglycemia, largely in patients treated with quinine, may complicate the cerebral symptomatology. Other central nervous manifestations of malaria include intracranial hemorrhage, cerebral arterial occlusion, and transient extrapyramidal and neuropsychiiatric manifestations. A self-limiting, isolated cerebellar ataxia, presumably caused by immunological mechanisms, in patients recovering from falciparum malaria has been recognized in Sri Lanka. Malaria is a common cause of febrile seizures in the tropics, and it also contributes to the development of epilepsy in later life. Several reports of spinal cord and peripheral nerve involvement are also available. A transient muscle paralysis resembling periodic paralysis during febrile episodes of malaria has been described in some patients. The pathogenesis of these neurological manifestations remains unexplored, but offers excellent perspectives for research at a clinical as well as experimental level.

Key words: malaria, Plasmodium falciparum, nervous system.

RESUMO

O envolvimento do sistema nervoso central pela malária é revisto neste artigo. Malária cerebral, a encefalopatia que complica exclusivamente a infecção pelo Plasmodium falciparum, atinge essencialmente crianças e adolescentes em áreas hiperendêmicas. Uma das hipóteses para a sua patogênese consiste no desvio dia circulação capilar por obstrução de capilares e vênulas cerebrais por eritrócitos parasitados. Outra, a teoria humoral, propõe que a resposta inflamatória, imunomediada e inespecífica, liberta substâncias vasoativas capazes de produzir alterações endoteliais e de permeabilidade. Malária cerebral tem taxa de mortalidade até 50% e também considerável morbidade a longo prazo, particularmente em crianças. A sintomatologia cerebral pode ser complicada por hipoglicemia, principalmente em doentes tratados com quinino. Outras manifestações incluem hemorragia intracraniana, oclusão arterial cerebral e sintomatologia transitória extrapiramidal e neuropsiquiátrica. Em Sri Lanka, alguns doentes em recuperação têm mostrado ataxia cerebelar, autolimitada, provavelmente devida a mecanismos imunes. Malária é causa frequente de convulsões febris nos trópicos e contribui para o desenvolvimento posterior de epilepsia. Envolvimento medular e dos nervos periféricos também têm sido descritos. Durante episódios febris, alguns doentes têm apresentado paralisia transitória semelhante à paralisia periódica. A patogênese das manifestações neurológicas na malária continua por ser esclarecida e oferece excelentes perspectivas de investigaçção tanto clínica como experimental.

Palavras chave: malária, Plasmodium falciparum, sistema nervoso.

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Dr. Gustavo C. Román — Neuroepidemiology Branch - Federal Building, Room 714 - 1550 Wisconsin Avenue - Bethesda, Maryland 20892 - USA.

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Neurological manifestations of malaria

Manifestações neurológicas da malária

Publication Dates

• Publication in this collection
  22 Feb 2011
• Date of issue
  Mar 1992