title: Decorticate, decerebrate and opisthotonic posturing and seizures in Kenyan children with cerebral malaria.
abstract: BACKGROUND
  Abnormal motor posturing is often observed in children with cerebral malaria, but the aetiology and pathogenesis is poorly understood. This study examined the risk factors and outcome of posturing in Kenyan children with cerebral malaria.
  
  
  METHODS
  Records of children admitted to Kilifi district hospital with cerebral malaria from January, 1999 through December, 2001 were reviewed for posturing occurring on or after admission. The clinical characteristics, features of raised intracranial pressure, number of seizures and biochemical changes in patients that developed posturing was compared to patients who did not.
  
  
  RESULTS
  Of the 417 children with complete records, 163 (39.1%) had posturing: 85 on admission and 78 after admission to hospital. Decorticate posturing occurred in 80, decerebrate in 61 and opisthotonic posturing in 22 patients. Posturing was associated with age > or = 3 years (48.1 vs 35.8%, p = 0.01) and features of raised intracranial pressure on funduscopy (adjusted OR 2.1 95%CI 1.2-3.7, p = 0.009) but not other markers of severity of disease. Unlike decorticate posturing, decerebrate (adjusted OR 1.9 95%CI 1.0-3.5) and opisthotonic posturing (adjusted OR 2.9 95%CI 1.0-8.1) were, in addition, independently associated with recurrence of seizures after admission. Opisthotonus was also associated with severe metabolic acidosis (OR 4.2 95%CI 3.2-5.6, p < 0.001). Thirty one patients with posturing died. Of these, 19 (61.3%) had features suggestive of transtentorial herniation. Mortality and neurological deficits on discharge were greatest in those developing posturing after admission.
  
  
  CONCLUSIONS
  Abnormal motor posturing is a common feature of cerebral malaria in children. It is associated with features of raised intracranial pressure and recurrence of seizures, although intracranial hypertension may be the primary cause.
authors.affiliation: Centre for Geographic Medicine Research-Coast, Kenya Medical Research, Kenya. ridro@kilifi.mimcom.net
authors.forename: Richard
authors.initials: R
authors.lastname: Idro
authors.forename: Godfrey
authors.initials: G
authors.lastname: Otieno
authors.forename: Steven
authors.initials: S
authors.lastname: White
authors.forename: Anderson
authors.initials: A
authors.lastname: Kahindi
authors.forename: Greg
authors.initials: G
authors.lastname: Fegan
authors.forename: Bernhards
authors.initials: B
authors.lastname: Ogutu
authors.forename: Sadik
authors.initials: S
authors.lastname: Mithwani
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.forename: Brian G R
authors.initials: BG
authors.lastname: Neville
authors.forename: Charles R J C
authors.initials: CR
authors.lastname: Newton
mesh_terms: D001933:Brain Stem / Q000473:pathology; D002675:Child, Preschool; D003128:Coma / Q000209:etiology; D003655:Decerebrate State / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000150:complications / Q000209:etiology; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D016779:Malaria, Cerebral / Q000150:complications* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy / Q000209:etiology*; D013997:Time Factors