Intensive Care Unit, Centre Hospitalier de Versailles, Hôpital André Mignot, 177, rue de Versailles, 78150 Le Chesnay, France.
Rev Neurol (Paris). 2019 Sep-Oct;175(7-8):445-450. doi: 10.1016/j.neurol.2019.07.008. Epub 2019 Jul 30.
During severe malaria, both in endemic and non-endemic areas, cerebral malaria is strongly associated with mortality and morbidity. The main mechanisms of cerebral malaria combine sequestration of parasitized red blood cells in brain capillaries, production of cytokines, immune cell/platelet accumulation, and release of microparticules, finally resulting in endothelial lesions of the blood brain barrier, which contribute to various brain injuries (oedema, ischemia, haemorrhages). The neurological clinical findings range from simple delirium to profound coma. Fundoscopy, reflect of the brain microcirculation, is now currently realized in endemic areas, and should be recommended during imported cerebral malaria. Likewise, cerebral imaging should be systematically realized in patients with cerebral malaria. Intravenous artesunate is now firmly established as the treatment of choice for severe malaria worldwide in adults, children and during pregnancy. General care and supportive treatment are crucially important and supportive treatment of cerebral malaria should be better standardized. Finally, experimental and clinical research has a key role in cerebral malaria, so as to identify possible therapeutic targets in order to develop innovative therapies.
在流行地区和非流行地区的严重疟疾中，脑型疟疾与死亡率和发病率密切相关。脑型疟疾的主要发病机制包括寄生红细胞在脑毛细血管中的扣押、细胞因子的产生、免疫细胞/血小板的聚集以及微颗粒的释放，最终导致血脑屏障内皮损伤，从而导致各种脑损伤（水肿、缺血、出血）。神经临床发现从单纯的意识混乱到深度昏迷不等。眼底镜检查，反映了脑部微循环，目前在流行地区得到了实现，并且应该在输入性脑型疟疾期间被推荐。同样，脑部成像应该在脑型疟疾患者中系统地实现。静脉注射青蒿琥酯现已被确定为成人、儿童和妊娠期间全球严重疟疾的首选治疗药物。一般护理和支持性治疗至关重要，脑型疟疾的支持性治疗应该得到更好的标准化。最后，实验和临床研究在脑型疟疾中具有关键作用，以便确定可能的治疗靶点，从而开发创新疗法。
