Residual neurologic sequelae after childhood cerebral malaria
van Hensbroek MB., Palmer A., Jaffar S., Schneider G., Kwiatkowski D.
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. STUDY DESIGN: 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. CONCLUSION: This finding raises the possibility that fatal outcome and neurologic sequelae arise from separate pathologic processes.