Residual neurologic sequelae after childhood cerebral malaria.
BACKGROUND
Cerebral malaria is an important cause of pediatric hospital admissions in the tropics. It commonly leads to neurologic sequelae, but the risk factors for this remain unclear and the long-term outcome unknown.


OBJECTIVE
The purpose of this study was to identify the common forms of neurologic sequelae that occur after cerebral malaria, their evolution over time, and the major clinical risk factors for residual disability.


METHODS
Prospective study in 624 children admitted with cerebral malaria to two hospitals in The Gambia, West Africa.


RESULTS
We found that 23.3% of survivors had neurologic sequelae on discharge from the hospital. By 1 month the proportion had decreased to 8.6%, and at 6 months only 4.4% of survivors were found to have residual neurologic sequelae. The most common forms of neurologic sequelae were paresis and ataxia, often found in combination with other neurologic abnormalities. In a multiple logistic regression analysis, depth of coma on admission, multiple convulsions, and duration of unconsciousness were the only three independent risk factors. Hypoglycemia and lactate acidosis were not predictive of sequelae, although they are important risk factors for fatality.


CONCLUSIONS
This finding raises the possibility that fatal outcome and neurologic sequelae arise from separate pathologic processes.
van Hensbroek
M B
MB
Medical Research Council Laboratories, Royal Victoria Hospital, Banjul, United Kingdom.
Palmer
A
A
Jaffar
S
S
Schneider
G
G
Kwiatkowski
D
D
D000140:Acidosis, Lactic / Q000209:etiology / Q000503:physiopathology; D000962:Antimalarials / Q000627:therapeutic use; D000077549:Artemether; D037621:Artemisinins; D001259:Ataxia / Q000209:etiology; D001927:Brain Diseases / Q000209:etiology* / Q000503:physiopathology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005544:Forecasting; D005714:Gambia; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D016015:Logistic Models; D008137:Longitudinal Studies; D016779:Malaria, Cerebral / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D010291:Paresis / Q000209:etiology; D010343:Patient Admission; D010351:Patient Discharge; D011446:Prospective Studies; D011803:Quinine / Q000627:therapeutic use; D012307:Risk Factors; D012640:Seizures / Q000209:etiology / Q000503:physiopathology; D012717:Sesquiterpenes / Q000627:therapeutic use; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014329:Tropical Climate; D014474:Unconsciousness / Q000209:etiology / Q000503:physiopathology
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D011803:Quinine; D000077549:Artemether