Cerebral venous and dural sinus thrombosis in severe falciparum malaria

Krishnan, A., Karnad, D. R., Limaye, U. and Siddharth, W. (2004) Cerebral venous and dural sinus thrombosis in severe falciparum malaria. Journal of Infection, 48 1: 86-90. doi:10.1016/S0163-4453(03)00130-0

Author Krishnan, A.
Karnad, D. R.
Limaye, U.
Siddharth, W.
Title Cerebral venous and dural sinus thrombosis in severe falciparum malaria
Journal name Journal of Infection   Check publisher's open access policy
ISSN 0163-4453
Publication date 2004-01
Year available 2003
Sub-type Article (original research)
DOI 10.1016/S0163-4453(03)00130-0
Volume 48
Issue 1
Start page 86
End page 90
Total pages 5
Place of publication London, United Kingdom
Publisher W.B. Saunders Co.
Language eng
Formatted abstract
Common causes of coma in falciparum malaria are cerebral malaria, hypoglycaemia and electrolyte disturbances. Focal deficits due to arterial infarcts may sometimes occur in children, but are rare in adults. Three adults with falciparum malaria who had fever, altered consciousness and focal neurological deficits (one of whom also had seizures) are being reported here. CT scan of the brain revealed haemorrhagic infarction of the cerebral cortex and subcortical white matter with surrounding oedema suggestive of venous infarction in all three patients. The diagnosis of cerebral venous thrombosis was missed in the first patient, and was detected only at autopsy. In the next two patients, superior sagittal sinus thrombosis was confirmed angiographically. Only one patient survived; the other two died of increased intracranial pressure. Two of the three patients also had Plasmodium vivax co-infection. A hypercoagulable state resulting from severe malaria may be responsible for this rare and potentially fatal complication. Cerebral malaria may be associated with raised intracranial pressure due to cerebral oedema. Cerebral venous thrombosis may worsen this and adversely affect outcome. This diagnosis should be suspected in patients with severe malaria who develop focal neurological deficits and confirmed by appropriate imaging; judicious use of local thrombolytic therapy may help improve outcome.
Keyword Plasmodium falciparum
Cerebral malaria
Cortical venous thrombosis
Superior sagittal sinus
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Available online 12 August 2003

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Created: Fri, 08 Apr 2011, 15:36:50 EST by Dr Anand Krishnan on behalf of Anaesthesiology and Critical Care - PAH