Article

Decorticate, decerebrate and opisthotonic posturing and seizures in Kenyan children with cerebral malaria

Centre for Geographic Medicine Research-Coast, Kenya Medical Research, Kenya.
Malaria Journal (Impact Factor: 3.49). 12/2005; 4. DOI: 10.1186/1475-2875-4-57
Source: DOAJ

ABSTRACT Background
Abnormal motor posturing is often observed in children with cerebral malaria, but the aetiology and pathogenesis is poorly understood. This study examined the risk factors and outcome of posturing in Kenyan children with cerebral malaria.

Methods
Records of children admitted to Kilifi district hospital with cerebral malaria from January, 1999 through December, 2001 were reviewed for posturing occurring on or after admission. The clinical characteristics, features of raised intracranial pressure, number of seizures and biochemical changes in patients that developed posturing was compared to patients who did not.

Results
Of the 417 children with complete records, 163 (39.1%) had posturing: 85 on admission and 78 after admission to hospital. Decorticate posturing occurred in 80, decerebrate in 61 and opisthotonic posturing in 22 patients. Posturing was associated with age ≥ 3 years (48.1 vs 35.8%, p = 0.01) and features of raised intracranial pressure on funduscopy (adjusted OR 2.1 95%CI 1.2–3.7, p = 0.009) but not other markers of severity of disease. Unlike decorticate posturing, decerebrate (adjusted OR 1.9 95%CI 1.0–3.5) and opisthotonic posturing (adjusted OR 2.9 95%CI 1.0–8.1) were, in addition, independently associated with recurrence of seizures after admission. Opisthotonus was also associated with severe metabolic acidosis (OR 4.2 95%CI 3.2–5.6, p < 0.001). Thirty one patients with posturing died. Of these, 19 (61.3%) had features suggestive of transtentorial herniation. Mortality and neurological deficits on discharge were greatest in those developing posturing after admission.

Conclusion
Abnormal motor posturing is a common feature of cerebral malaria in children. It is associated with features of raised intracranial pressure and recurrence of seizures, although intracranial hypertension may be the primary cause.

Download full-text

Full-text

Available from: Richard Idro, Jul 25, 2015
0 Followers
 · 
344 Views
  • Source
    • "For some reasons, the high pressure inside the skull may cause unnatural movements and demonstrations in children infected with malaria. This is a symptom of serious damage to the brain [11]. Malaria may become an agent causing cognitive disorders, especially in children. "
    The 12th International Congress of Immunology and Allergy of Iran, Iran; 01/2014
  • Source
    • "A large study in sub-Saharan Africa reported that almost 50% of malarial patients exhibited neurological deficits [15] encompassing a number of symptoms, including ataxia, seizures, hemiplegia, and eventually coma and death [13] [15] [16]. In addition, greater than 20% of children who survive an episode of cerebral malaria sustain persistent cognitive deficits, which can include memory impairment, visuospatial deficits, and psychiatric disorders as well as motor coordination dysfunction [2] [3] [6] [12] [20]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We have used cDNA microarrays to compare gene expression profiles in brains from normal mice to those infected with the ANKA strain of Plasmodium berghei, a model of cerebral malaria. For each of three brains in each group, we computed ratios of all quantifiable genes with a composite reference sample and then computed ratios of gene expression in infected brains compared to untreated controls. Of the almost 12,000 unigenes adequately quantified in all arrays, approximately 3% were significantly downregulated (P < 0.05, ≥ 50% fold change) and about 7% were upregulated. Upon inspection of the lists of regulated genes, we identified a high number encoding proteins of importance to normal brain function or associated with neuropathology, including genes that encode for synaptic proteins or genes involved in cerebellar function as well as genes important in certain neurological diseases such as Alzheimer's disease or autism. These results emphasize the important impact of malarial infection on gene expression in the brain and provide potential biomarkers that may provide novel therapeutic targets to ameliorate the neurological sequelae of this infection.
    Journal of neuroparasitology 10/2010; 1. DOI:10.4303/jnp/N100803
  • Source
    • "Annually, about 500 million acute cases and two million deaths mostly among young children under 5 years, 90% of which are in sub-Saharan Africa are reported. This approximates to a death every 30 s (Idro et al., 2007). There is at present an increased tempo globally in the search for new chemotherapeutic compounds against malaria. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Crude methanolic root extracts of Acacia nilotica Del. (Leguminoseae) demonstrated significant activity against chloroquine sensitive strain of Plasmodium berghei in mice. Purified extracts showed only a single fraction with significant antiplasmodial effects using bioguided essay techniques. The active A. nilotica isolate was highly polar dissolving readily in methanol, appeared as a single spot in different TLC conditions and was positive for tannins, melting with decomposition between 224 -229°C. Its 1 H NMR spectra exhibited large signals at S 6.90 -7.58 and 4.70 -5.00. The Mass spectra (ES1 -Msn) of the isolate gave a large M -1 signal of m/z 1395 consistent with the molecular formula C 62 H 43 O 38 . Others at 1243, 1091, 939, 787, 635, 453 and 331 that differ by m/z 152 were accounted for by the progressive loss of a galloyl (C 7 H 4 O 4) moiety. A polygalloyltannin structure containing a central glucosyl moiety corresponding with 1, 3, 6 – digalloyl – 2, 4 monogalloyltannin was hence postulated.
Show more