Neurological findings and outcome in adult cerebral malaria

The neurological findings of 100 patients of adult cerebral malaria were studied. The commonestneurological feature was symmetrical upper motor neuron lesion as evidenced by exaggerated tendonreflexes and bilateral planter extensor (61%). Twenty two percent had features of meningeal irritationand/or meningism. Abnormal posturing occurred decerebrate rigidity (6%) and decorticate rigidity(4%) with or without opisthotonus, focal neurological deficit was noted in 5% cases. Pupillary size andreaction were normal in 86%, poor in 14%. Corneal reflexes were absent in 4% cases. Fundoscopyshowed retinal hemorrhage in 16%, papilloedema is 3% and exudates in 1%. Majority of the patientsrecovered (80%) without any persistent neurological sequelae at the time of discharge from hospitaland death rate was 20%. Patients having focal neurological deficit, disconjugate gaze, poor pupillaryreaction, absent corneal reflex and papilloedema were more susceptible to death. Delay in hospitalization and deep coma were also associated with increased mortality, whereas early hospitalization and proper nursing care could reduce mortality.