Koch J, Strik W K, Becker T, Fleischer K, Gold R, Hofmann E
Psychiatrische Klinik, Universität Würzburg.
Nervenarzt. 1996 Jan;67(1):72-6.
Neuropsychiatric complications in the course of plasmodium falciparum infection are usually summarized as cerebral malaria. Heterogeneous clinical symptoms, different courses and inconstant parasitemia, however, suggest different pathogenic mechanisms. We report a case of an acute symptomatic psychosis occurring two weeks after successful therapy of a primary manifestation of plasmodium falciparum infection. The diagnosis of meningoencephalitis was based on lymphocytic pleocytosis of cerebrospinal fluid and hyperintense lesions in cranial magnetic resonance imaging. Due to the lack of plasmodium falciparum parasitemia and of serological evidence of viral infection a final diagnosis was not possible. Considering the pertinent literature, an immune-mediated complication of plasmodium falciparum infection (acute disseminated encephalomyelitis, ADEM) appears to be more probable than a direct viral or plasmodium CNS infection. We propose to reverse the term cerebral malaria for the cases with direct pathogenic influence of plasmodium falciparum, and to distinguish it from cases with possible immune-mediated pathogenesis.
恶性疟原虫感染过程中的神经精神并发症通常被归纳为脑型疟疾。然而，其临床症状各异、病程不同且疟原虫血症不稳定，提示存在不同的致病机制。我们报告一例在成功治疗恶性疟原虫感染的原发性表现两周后出现急性症状性精神病的病例。脑膜脑炎的诊断基于脑脊液淋巴细胞增多以及头颅磁共振成像中的高信号病变。由于缺乏恶性疟原虫血症以及病毒感染的血清学证据，无法做出最终诊断。考虑到相关文献，恶性疟原虫感染的免疫介导并发症（急性播散性脑脊髓炎，ADEM）似乎比直接的病毒或疟原虫中枢神经系统感染更有可能。我们建议将由恶性疟原虫直接致病影响的病例称为脑型疟疾，并将其与可能具有免疫介导发病机制的病例区分开来。
