Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Report
Case Series
Commentary
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Report
Case Series
Commentary
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
5 (
3
); 321-322

Commentary

Address for correspondence: Dr. José Eymard Homem Pittella, Department of Pathology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. E-mail: jehpittella@hotmail.com

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher; therefore Scientific Scholar has no control over the quality or content of this article.

Malaria continues to be the most significant parasitic disease of human in tropical countries. It has many forms of clinical presentations and complications, including cerebral malaria, anemia, thrombocytopenia, acute renal failure, respiratory distress, jaundice, hypoglycemia, metabolic acidosis, and disseminated intravascular coagulation.[1] Intracranial hemorrhage is a rare complication in malaria, with only 10 cases reported in the available literature.[234567891011] There were eight males and two females. Nine of these patients were adults, with ages ranging from 21 to 85 years, and one patient was a 3-year-old female. Infection with Plasmodium falciparum was found in eight patients, infection with Plasmodium vivax in one patient, and mixed infection with Plasmodium falciparum and Plasmodium vivax in one patient.

Subdural hematoma was the most common intracranial hemorrhage (five patients), followed by subarachnoid hemorrhage (three patients), extradural hematoma (two patients), intracerebral hematoma (two patients), and falx hemorrhage (one patient). The three cases of subarachnoid hemorrhage were associated with intracerebral hematoma (two cases) and subdural hematoma (one case). One patient with subdural hematoma also presented a subdural empyema. The diagnosis of intracranial hemorrhage was established by computed tomography scan of the head in eight patients and at autopsy in two other patients. There was no clinical evidence of the trauma, fall from height, seizures, bleeding diathesis, intake of anticoagulants or any drug abuse. In the autopsied patients, there were no signs of widespread bleeding diathesis. All patients presented with anemia and thrombocytopenia. The intracranial hemorrhage may have been caused by rupture of a small vessel plugged by red cells in combination with severe thrombocytopenia, as proposed initially by Gall et al.[3] In response to Plasmodium infection, proinflammatory cytokines are produced, such as TNF-α, which up-regulate endothelial adhesion molecules, promoting platelet and red cell sequestration in small vessels of the brain.[1213]

Intracranial hemorrhage in malaria is a potentially fatal complication. Six of the 10 patients died, including three of the six patients who had the hematoma surgically drained. These three patients died from infections in the postoperative period. Three other patients recovered after surgery, one of them with mild cognitive impairment. The patient with falx hemorrhage recovered after the treatment with antimalarial drugs, with no signs of permanent impairment at hospital discharge. The article by Kochar DK published in this online issue of Journal of Neurosciences in Rural Practice[14] provides further evidence on this serious hemorrhagic complication in malaria. Intracranial hemorrhages are a medical emergency and require immediate diagnosis and treatment, with evacuation of the hematoma and correction of the associated hematological complications. To avoid such complications, it is imperative to treat each and every malaria patient at the onset of first symptoms. Although intracranial hemorrhage in malaria is almost exclusively caused by Plasmodium falciparum, Plasmodium vivax may also cause this complication,[11] which confirms the view, initially expressed by Kochar et al.[15] in their detailed report of 11 patients, that Plasmodium vivax infection may also produce severe malaria.

References

  1. , , , . Parasitic and fungal infections. In: , , , eds. Greenfield's Neuropathology (8th ed). London: Hodder Arnold; . p. 1447-87.
    [Google Scholar]
  2. , , , , . Subarachnoid haemorrhage in Plasmodium falciparum malaria. Postgrad Med J. 1989;65:236-7.
    [Google Scholar]
  3. , , , . Subarachnoid hemorrhage in a patient with cerebral malaria. N Engl J Med. 1999;341:611-3.
    [Google Scholar]
  4. , , , , , . Foudroyanter Verlauf einer Malaria tropica. German Medical Weekly. 2001;126:76-8.
    [Google Scholar]
  5. , , , . Spontaneous subdural empyema in falciparum malaria: A case study. J Vector Borne Dis. 2004;41:80-2.
    [Google Scholar]
  6. , , , . A 57-year-old man with a 6-day headache and fatigue. Am J Med. 2005;118:219-21.
    [Google Scholar]
  7. , , , , , . Acute pancreatitis and subdural haematoma in a patient with severe falciparum malaria: Case report and review of literature. Malar J. 2008;7:97.
    [Google Scholar]
  8. , , , , . Falciparum malaria presenting as subdural hematoma. J Assoc Physicians India. 2011;59:325-6.
    [Google Scholar]
  9. , , , , . Spontaneous acute subdural hematoma in malaria: A case report. J Vector Borne Dis. 2011;48:247-8.
    [Google Scholar]
  10. , , , . Falciparum malaria troubling neurosurgeons. J Postgrad Med. 2012;58:61-2.
    [Google Scholar]
  11. , , , , . Extradural hematoma in plasmodium vivax malaria: Are we alert to detect? J Neurosci Rural Pract. 2013;4(Suppl 1):S145-6.
    [Google Scholar]
  12. , , . Role of platelet adhesion in homeostasis and immunopathology. Mol Pathol. 1997;50:175-85.
    [Google Scholar]
  13. , . Pathology of CNS parasitic infections. In: , , , eds. Neuroparasitology and Tropical Neurology. Vol 114. Amsterdam: Elsevier; . p. :65-88.
    [Google Scholar]
  14. , . Life threatening intracranial haemorrhages in malaria. J Neurosci Rural Pract. 2014;5:320.
    [Google Scholar]
  15. , , , , , , . Plasmodium vivax malaria. Emerg Infect Dis. 2005;11:132-4.
    [Google Scholar]

    Fulltext Views
    59

    PDF downloads
    3
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections