title: Corticosteroid-responsive postmalaria encephalopathy characterized by motor aphasia, myoclonus, and postural tremor.
abstract: OBJECTIVE
  To study the clinical spectrum of an acute severe encephalopathy occurring in 2 patients after recovery from falciparum malaria infection and to compare it with the reported clinical features of the postmalaria neurological syndrome.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Two patients presented with acute onset of fluctuating motor aphasia, severe generalized myoclonus, and postural tremor. Additional signs were cerebellar ataxia, and in 1 patient, generalized epileptic seizures. Magnetic resonance imaging of the brain revealed patchy white matter lesions in 1 patient. Clinically, the patients' conditions continued to worsen until corticosteroids were introduced, the use of which induced a rapid, albeit incomplete, recovery.
  
  
  CONCLUSIONS
  We describe a new, severe variant of the still poorly defined postmalaria neurological syndrome. We propose a preliminary classification of this syndrome, according to its clinical characteristics, as follows: a mild or localized form, characterized by isolated cerebellar ataxia or postural tremor; a diffuse, but relatively mild encephalopathic form, characterized by acute confusion or epileptic seizures; and a severe, corticosteroid-responsive encephalopathy that is characterized by motor aphasia, generalized myoclonus, postural tremor, and cerebellar ataxia.
authors.affiliation: Department of Neurology, University Hospital of Geneva, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Schnorf
authors.forename: K
authors.initials: K
authors.lastname: Diserens
authors.forename: H
authors.initials: H
authors.lastname: Schnyder
authors.forename: M
authors.initials: M
authors.lastname: Chofflon
authors.forename: L
authors.initials: L
authors.lastname: Loutan
authors.forename: V
authors.initials: V
authors.lastname: Chaves
authors.forename: T
authors.initials: T
authors.lastname: Landis
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001037:Aphasia / Q000209:etiology*; D005260:Female; D006801:Humans; D016779:Malaria, Cerebral / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009207:Myoclonus / Q000209:etiology*; D011187:Posture; D014202:Tremor / Q000209:etiology*
chemical_list: D000305:Adrenal Cortex Hormones