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Corticosteroid-Responsive Postmalaria Encephalopathy Characterized by Motor Aphasia, Myoclonus, and Postural Tremor
Hans Schnorf, MD;
Karin Diserens, MD;
Hans Schnyder, MD;
Michel Chofflon, MD;
Louis Loutan, MD;
Virginia Chaves, MD;
Theodor Landis, MD
Arch Neurol. 1998;55:417-420.
Objectives To study the clinical spectrum of an acute severe encephalopathy occurring in 2 patients after recovery from falciparum malaria infection and to compare it with the reported clinical features of the postmalaria neurological syndrome.
Design Case report.
Setting Tertiary care hospital.
Patients Two patients presented with acute onset of fluctuating motor aphasia, severe generalized myoclonus, and postural tremor. Additional signs were cerebellar ataxia, and in 1 patient, generalized epileptic seizures. Magnetic resonance imaging of the brain revealed patchy white matter lesions in 1 patient. Clinically, the patients' conditions continued to worsen until corticosteroids were introduced, the use of which induced a rapid, albeit incomplete, recovery.
Conclusions We describe a new, severe variant of the still poorly defined postmalaria neurological syndrome. We propose a preliminary classification of this syndrome, according to its clinical characteristics, as follows: a mild or localized form, characterized by isolated cerebellar ataxia or postural tremor; a diffuse, but relatively mild encephalopathic form, characterized by acute confusion or epileptic seizures; and a severe, corticosteroid-responsive encephalopathy that is characterized by motor aphasia, generalized myoclonus, postural tremor, and cerebellar ataxia.
From the Department of Neurology (Drs Schnorf, Diserens, Chofflon, Chaves, and Landis) and the Travel and Migration Medicine Unit, Department of Community Medicine (Dr Loutan), University Hospital of Geneva, Geneva, Switzerland; and the Department of Neurology, University of Zürich, Zurich, Switzerland (Dr Schnyder).
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