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Of 604 Gambian children admitted with falciparum malaria to one hospital between September and December,1988,308 had cerebral malaria and 203 were severely anaemic(haemoglobin<60 g/l).14%of those with cerebral malaria died,as did 7.8%of those with severe anaemia.32(12%)of children surviving cerebral malaria had residual neurological deficit.69 other children were admitted with clinical features strongly suggestive of cerebral malaria but with negative blood films;16 of these died and 3 had residual neurological deficits.The commonest sequelae of cerebral malaria were hemiplegia(23 cases),cortical blindness(11),aphasia(9),and ataxia(6). Factors predisposing to sequelae included prolonged coma,protracted convulsions,severe anaemia,and a biphasic clinical course characterised by recovery of consciousness followed by recurrent convulsions and coma.At follow up 1-6 months later over half these children had made a full recovery,but a quarter were left with a major residual neurological deficit.Cerebral malaria in childhood may be an important cause of neurological handicap in the tropics. |
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