A Cerebral Malaria Simulating an Epileptic Seizure

A 27-year-old patient, known epileptic and irregularly monitored since the age of three years. He was out of its antiepileptic treatment. He was admitted on August 12th 2015 for tonic clonic seizures associated with loss of consciousness. These subintrant convulsions (about a crisis every 30 minutes), taken at first for its seizure, led him to consult a health facility where he might have received care without success. Because of the persistence of crises, he was referred to YO University Hospital for better treatment. The examination upon admission revealed poor general condition with a clouded consciousness, colored anicteric conjunctiva, an infectious syndrome with a temperature at 39°C, moderate dehydration, a heart rate of 137 beats/min, high blood pressure at 140/90mmHg, haemoglobinuric urine. 

The thick smear came back positive, bicarbonates were lowered to 15 mmol/L, serum creatinine increased to 154.6 mmol/l. The diagnosis of severe malaria was selected. Under treatment based on artemether, PERFALGAN and bicarbonate infusion, the outcome was favourable and he was released from hospital on August 18th 2015. The occurrence of subintrant convulsive seizures in an epileptic patient should lead the clinician to systematically look for other causes of seizures such as cerebral malaria. To do this, health workers should be consequently trained.Read more....