What Are the Treatments for Cerebral Malaria?

Cerebral malaria is an acute brain illness that develops as a complication in many individuals infected with the malaria-causing parasite Plasmodium falciparum. Researchers are not certain how this condition is triggered, but once it begins it accelerates rapidly. Left unchecked, it is fatal in one to three days. The treatment for cerebral malaria involves the use of systemic medications to kill off the underlying parasite, as well as steps to address accompanying symptoms.

Understanding Cerebral Malaria

• Cerebral malaria occurs when red blood cells infected by P. falciparum collect in the tiny blood vessels that supply the brain with oxygen and nutrients. In some cases, noninfected blood cells are also involved. In either case, the result of this action is a blockage that leads to progressive blood deprivation and death of brain tissue. Unlike stroke, another illness with acute brain effects, the damage from cerebral malaria occurs in blood vessels throughout the brain.

  If you suffer the effects of cerebral malaria, you will already have symptoms of primary malarial infection, including sweating, chills, high fever, headache, diarrhea, nausea and vomiting. The defining additional characteristic of malaria with brain involvement is an unresponsive coma. This may also be accompanied by seizures and elevated pressure levels in the cranium.

Treating the Primary Infection

• If you fall into a malarial coma, your doctors will work quickly to treat your condition. In normal malaria cases, the drug chloroquine is commonly used, but in cases of cerebral malaria doctors generally assume that resistance to chloroquine is present. In its place you will likely receive quinine, another malaria drug that disrupts the digestive processes of P. falciparum.

  You may also receive a new drug called Coartem, approved by the U.S. Food and Drug Administration in 2009 for treatment of cerebral malaria. This commercial product is a combination of two drugs, artemether and lumefantrine. Artemether is a chemical derivative of arteminisin, a naturally occurring compound used for centuries in Chinese medicine. While it is highly effective in fighting P. falciparum, its actions in the body are quite short-lived. The addition of lumefantrine, an antibiotic, extends the effectiveness of treatment and allows doctors to address lingering P. falciparum infection.

Treating Seizure Symptoms

• In addition to treatment to eradicate P. falciparum, you will receive medication for seizures if they occur. Common choices include intravenous or rectal doses of diazepam (Valium) and intramuscular injection of the anticonvulsant paraldehyde.

Coma Support

• You will also receive care to protect your body during coma. This will include monitoring of fluid intake and urine output, steps to keep your airway open, regular turning of your body position and constant monitoring of your vital signs. Other chemical markers will also be monitored, including your blood glucose and sodium concentration. If you experience a dangerously high fever, you will also receive a sponge bath or other method of temperature relief.

Recovery

• If your cerebral malaria is properly diagnosed and treated, your chances for recovery are excellent. The coma typically ends after a 72-hour period, and roughly 90 percent of patients who survive this crisis point have no residual brain injury.