Posted by Dr. Bijoykumar Barik on Thursday, 22nd July 2010AIM:
To study incidence of neuropsychiatric manifestations and post malarial neurological sequelae in patients of falciparum malaria.
MATERIALS AND METHODS:
Patients with fever and MP (slide, QBC) showing PFR positive were enrolled for this study and detail history, general examination, neurological examination and psychiatric evaluation including mini mental score, routine examination, CT scan of brain were done at the time of admission, during hospital stay, after recovery and during follow up.
OBSERVATION AND DISCUSSION:
Fourty (40) patients were enrolled in this study, of which 32(80%) were male and 8 (20%) female. The clinical presentation at the time of admission was fever (100%), anemia (77.5%), impaired consciousness(32.5%), psychosis (25%), convulsion (17.5%), , hypotension (13%), only 12.5% patients were deeply comatose with GCS score 7, out of which one (1) patient died.During hospital stay, 2.5% patients developed focal neurological deficit 12.5% patients depression, 5% patients speech disorder in the form of dysarthria, 5% patients memory loss & 5% patients developed acute cerebellar syndrome. Mini mental score (MMS) examination of patients after completion of antimalarial treatment revealed two (2) patients with MMS 21 i.e., they were showing cognitive impairment. Heavy parasitemia was observed, particularly in more numbers of patients with coma and depression. High blood urea (> 49 mg%) was seen to be correlated with impaired consciousness, psychosis, depression and memory loss with p value < 0.005. Three (3) of the patients developed post malarial neurological syndrome in the form of psychosis(1), delayed cerebellar ataxia (1) and memory loss (1).
Neuropsychiatric manifestations are important aspects of clinical features of falciparum malaria, because of it unique characteristics leading to micro vascular involvement. Heavy parasitemia and high blood urea were well correlated with most neuropsychiatric manifestations of falciparum malaria which needs further discussion. So proper anti-malarial treatment needs to be instituted promptly to avoid these complications and postmalarial neurological syndrome to a minimum.