Click here for larger view. A thin smear shows abundant parasites consistent with plasmodium falciparum . The patient was given intravenous quinidine gluconate and then subsequently underwent exchange transfusion. The procedure decreased the level of parasitemia to Comment Cerebral malaria is usually an acute, diffuse, symmetric encephalopathy in patients with malaria. In severe cases, there is coma.
Seizures often intercede, both generalized and focal, and coma can last for several days.
Gross autopsy findings in patients who died with cerebral malaria include opacification of the leptomeninges, dusky discoloration of the grey matter, edema, congestion, and petechial hemorrhages. Histologic examination reveals blockage of cerebral capillaries by erythrocytes, many of which are parasitized in various stages of maturation. Hemorrhages are found throughout, but are more common in the white matter and may surround necrotic arterioles and veins. Glial proliferation occurs in the ischemic parenchyma. There also may be a monocytic inflammatory infiltrate.