Neurologic sequelae may follow cerebral malaria in children. Children at greater risk for neurologic sequelae can be identified based on clinical findings during the illness.
Patient population: children with cerebral malaria from Gambia, West Africa
Neurologic sequelae seen:
(1) ataxia (common)
(2) paresis (common)
(3) hearing defects
(4) visual field defects
(5) aphasia
(6) behavioral problems (restlessness, concentration problems, hallucinations, aggression)
(7) developmental regression
(8) recurrent convulsions (uncommon)
Frequency of neurologic sequelae:
(1) at discharge from hospital: 23.3% of survivors
(2) 1 month after discharge: 8.6%
(3) 6 months after discharge: 4.4%
(4) 18 months and longer: most of those affected at 6 months showed residual neurologic sequelae
Number of neurologic sequelae and subsequent course:
(1) Children with only one neurologic abnormality were more likely to make a full recovery than those with multiple neurologic abnormalities.
|
Predictors of Neurologic Sequelae
|
Odds Ratio (95% CI)
|
|
Blantyre coma score of 0 or 1 on admission
|
7.4 (1.8 - 29.7)
|
|
multiple convulsions
|
13.4 (3.4 - 52.4)
|
|
duration of unconsciousness
|
7.1 (2.2 - 22.7)
|
Duration of unconsciousness and neurologic sequelae:
(1) coma for 2 days: 14% of children had sequelae
(2) coma for more than 5 days: 39%
Since convulsions are an important risk factor for neurologic sequelae and the one factor with an intervention strategy, their control is important.
