CORTICOSTEROID-RESPONSIVE POSTMALARIA ENCEPHALOPATHY CHARACTERIZED BYMOTOR APHASIA, MYOCLONUS, AND POSTURAL TREMOR

Objectives: To study the clinical spectrum of an acute severe encephal opathy 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: Tert iary care hospital. Patients: Two patients presented with acute onset of fluctuating motor aphasia, severe generalized myoclonus, and postur al tremor. Additional signs were cerebellar ataxia, and in 1 patient, generalized epileptic seizures. Magnetic resonance imaging of the brai n revealed patchy white matter lesions in 1 patient. Clinically, the p atients' conditions continued to worsen until corticosteroids were int roduced, the use of which induced a rapid, albeit incomplete, recovery . Conclusions: We describe a new, severe variant of the still poorly d efined postmalaria neurological syndrome. We propose a preliminary cla ssification of this syndrome, according to its clinical characteristic s, as follows: a mild or localized form, characterized by isolated cer ebellar ataxia or postural tremor; a diffuse, hut relatively mild ence phalopathic form, characterized by acute confusion or epileptic seizur es; and a severe, corticosteroid-responsive encephalopathy that is cha racterized by motor aphasia, generalized myoclonus: postural tremor, a nd cerebellar ataxia.