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Overview :
Neurologic sequelae may follow cerebral malaria in children.
Children at greater risk for neurologic sequelae can be identified based on
clinical findings during the illness.
Patient population: children with cerebral malaria from Gambia,
West Africa
Neurologic sequelae seen:
(1) ataxia
(common)
(2) paresis
(common)
(3) hearing
defects
(4) visual
field defects
(5)
aphasia
(6)
behavioral problems (restlessness, concentration problems, hallucinations,
aggression)
(7)
developmental regression
(8)
recurrent convulsions (uncommon)
Frequency of neurologic sequelae:
• at discharge
from hospital: 23.3% of survivors
• 1 month
after discharge: 8.6%
• 6 months
after discharge: 4.4%
• 18 months
and longer: most of those affected at 6 months showed residual neurologic
sequelae
Number of neurologic sequelae and subsequent course:
• Children
with only one neurologic abnormality were more likely to make a full recovery
than those with multiple neurologic abnormalities.
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Predictors of
Neurologic Sequelae |
Odds Ratio (95% CI) |
|
Blantyre coma score of 0 or 1 on admission |
7.4 (1.8 -
29.7) |
|
multiple convulsions |
13.4 (3.4 -
52.4) |
|
duration of unconsciousness |
7.1 (2.2 -
22.7) |
Duration of unconsciousness and neurologic sequelae:
• coma for 2 days: 14% of children had sequelae
• coma for more than 5 days: 39%
Since convulsions are an important risk factor for neurologic
sequelae and the one factor with an intervention strategy, their control is important.
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