Sattar M A, Hoque Hasnat Waheed, Amin M Robed, Faiz M A, Rahman M Ridwanur
Department of Medicine, Chittagong Medical College, Chittagong, Bangladesh.
Bangladesh Med Res Counc Bull. 2009 Apr;35(1):15-7. doi: 10.3329/bmrcb.v35i1.2313.
The neurological findings of 100 patients of adult cerebral malaria were studied. The commonest neurological feature was symmetrical upper motor neuron lesion as evidenced by exaggerated tendon reflexes and bilateral planter extensor (61%). Twenty two percent had features of meningeal irritation and/or meningism. Abnormal posturing occurred decerebrate rigidity (6%) and decorticate rigidity (4%) with or without opisthotonus, focal neurological deficit was noted in 5% cases. Pupillary size and reaction were normal in 86%, poor in 14%. Corneal reflexes were absent in 4% cases. Fundoscopy showed retinal hemorrhage in 16%, papilloedema is 3% and exudates in 1%. Majority of the patients recovered (80%) without any persistent neurological sequelae at the time of discharge from hospital and death rate was 20%. Patients having focal neurological deficit, disconjugate gaze, poor pupillary reaction, absent corneal reflex and papilloedema were more susceptible to death. Delay in hospitalization and deep coma were also associated with increased mortality, whereas early hospitalization and proper nursing care could reduce mortality.
对100例成人脑型疟疾患者的神经学表现进行了研究。最常见的神经学特征是对称性上运动神经元损害，表现为腱反射亢进和双侧巴宾斯基征阳性（61%）。22%的患者有脑膜刺激征和/或假性脑膜炎的表现。出现异常姿势的有去大脑强直（6%）和去皮质强直（4%），伴或不伴有角弓反张，5%的病例有局灶性神经功能缺损。86%的患者瞳孔大小及反应正常，14%较差。4%的病例角膜反射消失。眼底检查显示16%有视网膜出血，3%有视乳头水肿，1%有渗出物。大多数患者（80%）在出院时康复且无任何持续性神经后遗症，死亡率为20%。有局灶性神经功能缺损、眼球分离性斜视、瞳孔反应差、角膜反射消失和视乳头水肿的患者更容易死亡。住院延迟和深度昏迷也与死亡率增加有关，而早期住院和适当的护理可以降低死亡率。
