Olweny C L, Chauhan S S, Simooya O O, Bulsara M K, Njelesani E K, Van Thuc H
J Trop Med Hyg. 1986 Jun;89(3):123-9.
Fifty-six adult patients diagnosed as having 'cerebral malaria' were admitted and treated over a 4 month period. The presenting symptoms were similar to those of control patients with malaria without cerebral manifestations except that vomiting and convulsions were significantly more frequent and joint pains were less frequent in the cases than in the controls. Physical examination revealed significantly more frequent occurrence of nuchal rigidity, positive Kernig's sign, confusion, muteness, pallor and jaundice in the cases than controls, while splenomegaly was significantly more common in controls than cases. Laboratory data showed that cerebral malaria cases had significantly lower haemoglobin and significantly higher reticulocyte count and erythrocyte sedimentation rate than controls. There was no significant difference in the parasite density between the cases and controls. All patients were treated with 200 mg base of intravenous chloroquine in 250 ml of isotonic saline infused over 2 h and repeated 12 hourly till oral therapy was possible. This proved to be efficacious and the recovery rate was over 90%. Five patients died and the diagnosis was confirmed in three in whom autopsy was permitted. A simple staging system is proposed which retrospectively seems to have prognostic value. It is recommended that the validity of this system be tested prospectively.
在4个月期间，收治了56例被诊断为“脑型疟疾”的成年患者并进行治疗。其呈现的症状与无脑部表现的对照疟疾患者相似，只是病例组中呕吐和惊厥明显更频繁，而关节疼痛比对照组更少。体格检查发现，病例组中颈项强直、克氏征阳性、意识模糊、缄默、面色苍白和黄疸的发生率明显高于对照组，而脾脏肿大在对照组中比病例组更常见。实验室数据显示，脑型疟疾病例的血红蛋白明显低于对照组，网织红细胞计数和红细胞沉降率明显高于对照组。病例组和对照组之间的寄生虫密度没有显著差异。所有患者均接受200mg碱的静脉注射氯喹，溶于250ml等渗盐水中，在2小时内输注完毕，每12小时重复一次，直至可以进行口服治疗。这被证明是有效的，恢复率超过90%。5例患者死亡，3例进行了尸检，诊断得到证实。提出了一个简单的分期系统，回顾性来看似乎具有预后价值。建议对该系统的有效性进行前瞻性测试。
