Postmalaria neurological syndrome: a case of acute disseminated encephalomyelitis?

We report on a 30 year old woman presenting with neurological dysfunction 8 weeks after complete recovery from Plasmodium falciparum malaria. Magnetic resonance imaging during her illness showed multifocal white matter abnormalities. She made a full recovery without any specific treatment. Repeat MRI 6 months after her acute illness showed complete resolution of all lesions. Although the term postmalaria neurological syndrome has been used to describe such cases, the clinical and radiological findings are indistinguishable from those seen in acute disseminated encephalomyelitis. The term postmalaria neurological syndrome (PMNS) was first introduced in 1996.1 The syndrome has been defined as the acute onset of neurological or neuropsychiatric symptoms in patients recently recovered from Plasmodium falciparum malaria who have negative blood films at the time of onset. This therefore distinguishes it from cerebral malaria, which occurs during parasitaemia. The time from eradication of the systemic parasitaemia to the development of this syndrome can be up to 9 weeks (median 4 days).1 The prevalence of PMNS in patients with Plasmodium falciparum malaria is 0.12%. PMNS is 300 times more common in patients with severe rather than uncomplicated malaria.1 The reported clinical features include generalised convulsions, acute confusional state, acute psychosis, and tremor. The range of neurological manifestations of PMNS is probably wider and includes cerebellar ataxia (first reported in 1986),2 motor aphasia, and generalised myoclonus.3 Most cases made a complete recovery without specific treatment. We report a case of PMNS where MRI was performed during …