Hamann G, Schimrigk K
Universitäts-Nervenklinik-Neurologie, Universität des Saarlandes, Homburg/Saar.
Fortschr Neurol Psychiatr. 1993 Feb;61(2):46-54. doi: 10.1055/s-2007-999075.
Infections with malaria are increasing in Europe and Northern America and are also spreading in tropical endemic areas. A falciparum variety of malaria known as cerebral malaria is the most well-known neurological complication, caused by Plasmodium falciparum and characterised by a fulminant course with disturbances of consciousness and facultative seizures or focal neurological deficits. 50% of deaths caused by malaria are due to cerebral involvement. Pathologically a disseminated vasculomyelinopathic disorder is seen. Immunological changes, vascular-hypoxic disturbances and metabolic-toxic factors contribute to these pathological findings. Facts on diagnostic, differential diagnostic and therapeutic procedures are presented. Beside the severe and life-threatening cerebral malaria some unspecific cerebral symptoms are seen, such as cerebellar ataxia and chorea. Spinal disease and peripheral nerve involvement, polyradiculitis and especially psychiatric disorders have also been described. Every neurological and psychiatric disorder presented first in tropical areas or malaria-endemic regions requires malaria diagnostic tests. In our geographical region, any previous history of a journey to the tropics is an important pointer; in particular, neurological or psychiatric symptoms can be important pointers to malaria.
疟疾感染在欧洲和北美呈上升趋势，并且也在热带流行地区蔓延。一种被称为脑型疟疾的恶性疟原虫变种是最广为人知的神经并发症，由恶性疟原虫引起，其特征是病程凶险，伴有意识障碍以及偶发癫痫或局灶性神经功能缺损。疟疾导致的死亡中有50%归因于脑部受累。病理上可见一种播散性血管髓鞘病。免疫变化、血管缺氧紊乱和代谢毒性因素促成了这些病理表现。文中介绍了诊断、鉴别诊断和治疗程序方面的情况。除了严重且危及生命的脑型疟疾外，还可见一些非特异性脑部症状，如小脑共济失调和舞蹈症。脊髓疾病和周围神经受累、多发性神经根炎，尤其是精神障碍也有相关描述。在热带地区或疟疾流行地区首次出现的每一种神经和精神障碍都需要进行疟疾诊断检测。在我们所在的地理区域，以往任何前往热带地区的旅行史都是一个重要线索；特别是神经或精神症状可能是疟疾的重要线索。
