Intracerebral bleed, right haemiparesis and seizures: an atypical presentation of vivax malaria.

Falciparum malaria is notoriously known to produce life-threatening complications. Despite growing reports of chloroquine resistance and severe disease, vivax malaria continues to be viewed as a benign disease. We report a rare case of a 47-year-old healthy man from a malaria-endemic region, presenting with intracerebral bleed, right haemiparesis, aphasia and seizures following vivax malaria. This was successfully managed conservatively, without any neurosurgical intervention, with combination therapy of intravenous artesunate, oral hydroxychloquine and primaquine. In a country where Plasmodium vivax is responsible for majority of cases of malaria, it is high time the national malaria control programmes focus on the elimination of P. vivax in addition to its more dangerous counterpart, P. falciparum.

Dirofilaria repens infection and concomitant meningoencephalitis.

Dirofilaria repens, a filarial nematode of dogs and other carnivores, can accidentally infect humans. Clinical symptoms are usually restricted to a subcutaneous nodule containing a single infertile parasite. Here, we report a case of D. repens infection with a subcutaneous gravid worm and the patient's concomitant meningoencephalitis and aphasia.

Alveolar echinococcosis of liver presenting with neurological symptoms due to brain metastases with simultaneous lung metastasis: a case report.

Alveolar echinococcosis (AE) is a chronic and serious, even lethal, parasitic infection caused by the helminth Echinococcus multilocularis (EM). AE is an endemic disease in Turkey and it is particularly common in people living in the eastern Anatolia Region. In addition to various clinical presentations, symptoms which lead to diagnosis, however, are usually associated with the metastatic lesions. We herein reported a 62-year-old man who had liver alveolar hydatid disease with simultaneous lung and brain metastasis. We think there was only one therapeutic option, namely medical treatment with albendazol, which is the usual treatment for patients living in eastern Anatolia and who are admitted late resulting in a subsequent inoperable situation. Thus, radiological screening studies for the public in this region may increase the possibility of surgical treatment for alveolar hydatid disease.

Clinical study of cerebral malaria in African children.

Of 51 consecutive children with cerebral malaria, fever, convulsions, and drowsiness were the commonest presenting symptoms. Decerebrate and decorticate postures and absent cornea reflex were the commonest brain stem signs. Opening lumbar cerebrospinal (CSF) pressure was raised in all but one of 24 children in whom it was reliably measured [mean 15.2 +/- 5.7 mmHg, range 6-24]. Hyponatraemia occurred in 17 (33%). Acute renal failure was not uncommon; the combination of hypercreatininaemia (plasma creatinine > 100 mumol/L) and hyperkalaemia (plasma potassium > 6.0 mumol/L) was fatal in 5 out of 7 patients in whom it occurred. Disturbances of acid-base status were present in all 40 children in whom it was assessed on admission. Mortality rate was 16% (8 patients). Neurological deficits occurred in 7 (14%) of the survivors and included cortical blindness [3], aphasia [3], hypertonia [3], hearing loss [2], and dystonia [1]. In addition to the present measures aimed at reducing morbidity and morality in children with cerebral malaria, efforts should be directed at rapid assessment of renal function and prompt correction of such dysfunction if found.