Hijazi Mohamad, Abdalla ELMustafa, Fadul Abdalla, Eltayeb Doaa Ahmed, Al-Mashdali Abdulrahman
Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
Ann Med Surg (Lond). 2022 Aug 19;81:104462. doi: 10.1016/j.amsu.2022.104462. eCollection 2022 Sep.
Malaria is a common parasitic infection with a wide range of clinical presentations. Thus, it should be suspected for any symptomatic patient with a recent travel history to a malaria-endemic area.
In this case report, we will present a previously healthy 28-year-old patient who developed cerebellar signs that were attributed to infectious etiology later on proven to be a malaria-related complication that responded well to anti-malarial medications.
The classical presentation of malaria with attacks of fever is noticed only in around 60% of the patients. The development of immunity, the increasing resistance to anti-malarial drugs, and the indiscriminate use of anti-malarial drugs have led to malaria presenting unusual characteristics. Cerebellar ataxia, extrapyramidal signs, and various psychiatric manifestations have been described as early presentations of cerebral malaria or as a part of the post-malaria neurological syndrome. Other neurological syndromes like peripheral neuropathies, movement disorders, myelopathies, and stroke-like syndrome have also been described.
Malaria should be included as a differential diagnosis in a patient presenting with cerebellar signs as its devastating if left untreated. However, it responds well to anti-malarial regimens if started early during the course.
疟疾是一种常见的寄生虫感染,临床表现多样。因此,对于近期有前往疟疾流行地区旅行史的任何有症状患者,都应怀疑患有疟疾。
在本病例报告中,我们将介绍一名此前健康的28岁患者,该患者出现了小脑体征,最初归因于感染性病因,后来被证明是与疟疾相关的并发症,对抗疟药物反应良好。
只有约60%的患者会出现疟疾典型的发热发作表现。免疫力的发展、对抗疟药物耐药性的增加以及抗疟药物的滥用导致疟疾呈现出不寻常的特征。小脑共济失调、锥体外系体征和各种精神症状已被描述为脑型疟疾的早期表现或疟疾后神经综合征的一部分。其他神经综合征,如周围神经病、运动障碍、脊髓病和类中风综合征也有报道。
对于出现小脑体征的患者,应将疟疾列为鉴别诊断之一,因为如果不治疗,后果严重。然而,如果在病程早期开始抗疟治疗,其对抗疟方案反应良好。