Cerebral malaria in Indian adults: a prospective study of 441 patients from Bikaner, north-west India.

AIMS OF THE STUDY: As per WHO (1993) the assessment and analysis of local problems and an appropriate epidemiological information system is an essential part of a control programme before embarking any control activity. METHODOLOGY: Four hundred and fourty one (441) adults of strictly defined admitted cerebral malaria patients were studied. Detailed clinical/neurological examination was done at the time of admission, daily thereafter, at the time of regaining consciousness, at the time of discharge and at weekly intervals in those having neurological sequelae. All patients were treated by i.v./oral quinine and specific syndromes were managed according to WHO guidelines. RESULTS: Apart from fever and unconsciousness in all the patients, other features were convulsion (21.31%), neck rigidity (19%), psychosis (5.21%), conjugate deviation of eyes (2.26%), extrapyramidal rigidity (2.25%), trismus (1.31%), decorticate rigidity (1.13%) and decerebrate rigidity (0.90%). One hundred forty five (32.87%) patients expired and mortality was highest in pregnant ladies (39.28%). The important neurological sequelae in survivors were psychosis in 15 (5.06%), cerebellar ataxia in 14 (4.72%), hemiplegia in five (1.68%), extrapyramidal rigidity (EPR) in four (1.35%), peripheral neuropathy in three (1.01%), EPR with trismus in one (0.33%) and isolated sixth nerve palsy in one (0.33%) patients and all showed complete recovery in further follow up. CONCLUSION: The important observations of this study were stormy presentation, increased incidence of haemoglobinuria and jaundice, presence of neck rigidity, no prognostic relation to fundus abnormalities and high incidence of cerebellar ataxia and psychosis as neurological sequelae in survivors. Knowledge of self-limiting course of neurological sequelae may be helpful in reducing economic strain of expensive investigations and treatment.

Somatosensory evoked potentials (SSEPs); sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) in chronic renal failure.

Somatosensory evoked potentials, sensory and motor nerve conduction velocity were studied in 25 patients of chronic renal failure and the results were compared with 15 healthy persons. The values more than +/- 3 S.D. were considered abnormal. SNCV was reduced in 11/25 patients; average reduction being 18 m/s (highly significant, p < 0.001); MNCV was reduced in 11/25 patients, average reduction being 20 m/s (highly significant, p < 0.001). Both SNCV and MNCV in same person were reduced in 6/25 patients. In SSEP N9, N13 and N20 were delayed in almost all the patients (highly significant, p < 0.001). Amplitude of N20 and N13 were reduced in 1 and 4 patients respectively but amplitude of N9 was normal. Out of different IPLS, Ebw-N9 was delayed in 5/25 patients (p < 0.9, insignificant); N9-N13 was delayed in 8/25 patients (p < 0.001, highly significant); N13-N20 was delayed in 1/25 patients (p < 0.01, significant). The evidence of these neurophysiological abnormalities collectively suggest the presence of central-peripheral axonopathy in this disease.

Somatosensory evoked potentials in cerebral malaria. A preliminary study.

Somatosensory evoked potentials were recorded in patients of cerebral malaria by (R) median nerve stimulation. Important observations of this study were delayed absolute latency of N20, increased N13-N20 IPL i.e. central conduction time and distorted and dispersed waveforms of N9 and N20 peaks. The possible pathologic mechanism is discussed.