J Neurocrit Care.  2023 Dec;16(2):101-106. 10.18700/jnc.230034.

A case report of pitfall of fever and altered mental status: cerebral malaria due to Plasmodium falciparum in an adult traveler returning from Congo

• Park SH
• Kim Y
• Kim YJ
• Bae JS
• Lee JH

• KMID: 2549487
• DOI: http://doi.org/10.18700/jnc.230034

Abstract

Background
Cerebral malaria, caused by Plasmodium falciparum, can lead to severe neurological complications. It is more frequently observed in children than in adults. Because cerebral malaria is rare and has no specific symptoms or neurologic findings, it is not easy to diagnose.
Case report
We report a case of a 61-year-old male who returned from the Democratic Republic of the Congo with fever, fatigue, and confusion. With considering cerebral malaria, a peripheral blood smear confirmed P. falciparum infection (initial parasite load, 760,800/μL; ring form, 100%). Cerebrospinal fluid analyses showed high protein level (103.2 mg/dL). Electroencephalograms showed background slowing activity. Brain magnetic resonance imaging showed signal changes and cerebral swelling. The initial doxycycline and quinidine treatment for malaria was successful without sequalae.
Conclusion
Physicians must have high suspicion about the symptoms and the necessity for screening in individuals traveling to malaria-endemic regions when experiencing changes in consciousness.

Keyword

Malaria; Cerebral malaria; Altered mental status; Doxycycline; Quinidine

Figure

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  Fig. 1. Timeline of malaria burden and symptoms progression. The measured malaria burden (black line), level of consciousness (blue line), and cognitive function test results (green line) are related to the treatment. GCS, Glasgow Coma Scale; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment.

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  Fig. 2. Patient’s electroencephalography (EEG). EEG displays background slowing activity.

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  Fig. 3. Brain magnetic resonance imaging. Diffusion-weighted image (A) displaying high signal intensities in the right hippocampal, limbic, and parieto-occipital cortices (white arrows). The fluid attenuated inversion recovery (B) exhibits high signal intensity in the same region (yellow arrows).

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  Fig. 4. Results of visuospatial and executive function test. The result of visuospatial and executive function improved after malaria treatment (B) compared before (A). On the 10th hospital day, the patient could write complete sentences (C).

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