Acute cerebellar ataxia associated with falciparum malaria in Nigerian patients

OBJECTIVE

To describe acute cerebellar ataxia seen in Nigeria patients with acute falciparum malaria.

PATIENTS, METHODS AND RESULTS

We report 5 patients seen at the Lagos University Teaching Hospital (LUTH) over a 3-year period with cerebellar ataxia (CA) following proven/presumed acute falciparum malaria. Two of them are children. The youngest is a 7-year-old girl and to our knowledge is the youngest child in which the syndrome has been reported. The mode of presentation is similar to that of patients previously reported with the syndrome from other parts of the world. the minimum duration of ataxia was 2 weeks, while the maximum duration was 6 weeks. All patients received prednisolone for the total duration of symptoms and there was complete resolution of ataxia in them all.

CONCLUSION

We suggest that CA associated with acute malaria occurs in Nigerians and that the features are similar to those described from other parts of the world. In comparison with cerebral malaria, this neurological complication of falciparum malaria has a good prognosis, resolving completely in virtually all cases. There is therefore the need to be on the look out for it, in order to appropriately counsel patients.

Cerebellar ataxia due to Toxocara infection in Mongolian gerbils, Meriones unguiculatus

We assessed the usefulness of gerbils as an experimental model for neurologic toxocarosis. Mongolian gerbils, Meriones unguiculatus, infected with Toxocara canis or Toxocara cati (1000 eggs/gerbil) showed progressive neurologic disorders from 50 days after infection in T. canis-infected gerbils or from 120 days after infection in T. cati-infected gerbils. The incidence of the onset was 6 of the 13 gerbils (49%) in the T. canis-gerbils and 5 of the 7 gerbils (71%) in the T. cati-gerbils. Histopathologically, the cerebellum was the most affected in both groups. We observed loss of Purkinje cells, glial nerve fibers, and nerve sheaths. We also found foci consisting of aggregated macrophages scattered in the white matter of the cerebellum. The affected gerbils showed ataxia and ultimately died of cachexia. Our findings suggest that irreversible neurologic toxocarosis in gerbils can be induced by infection with either T. canis or T. cati.

Post malaria cerebellar ataxia and ocular flutter: report of two cases

We report two cases of post malarial cerebellar ataxia presenting with severe ocular flutter, in a female of 72 years and a male of 20 years. Both patients had falciparum malaria infection. CT scans of both patients were within normal limits for the age. Cerebellar signs as well as ocular flutter responded very well to moderate doses of prednisolone therapy.

Post-malarial cerebellar ataxia in adult Sudanese patients

In this study the clinical manifestation and the effect of corticosteroids on the course and the outcome of post malaria cerebellar ataxia on thirty adult Sudanese patients wr investigated. Twenty four patients with delayed ataxia, that is, ataxia occurring shortly after full recovery from otherwise uncomplicated, documented malaria and six patients who were found to be ataxic on recovery from cerebral malaria were included in the study. The distribution of the age, sex and various clinical aspects were outlined. Twelve randomly selected patients were given oral prednisolone. The corticosteroid was found to shorten the period of ataxia. It was also found that in patients who demonstrated cerebellar infarction or atrophy on computerised tomography the duration of ataxia was significantly long.

Delayed cerebellar ataxia: a new complication of falciparum malaria?

Twelve cases of an unusual phenomenon of ataxia were investigated in otherwise well, conscious patients recovering from a febrile attack of presumed falciparum malaria. The ataxia occurred as the fever was subsiding, usually after an afebrile period of two to four days. The delay between onset of fever and the ataxia was three to four weeks. Peripheral blood of all the patients contained gametocytes of Plasmodium falciparum, and in some cases ring stages. The ataxia was most noticeable in the legs and the clinical picture suggested selective impairment of the cerebellar system. Signs of improvement appeared in a few weeks but complete recovery took one to four months. The most likely pathogenic mechanism of the ataxia in these cases was an immune reaction triggered by the malaria parasite and affecting the cerebellum or its connections, or both.