Skip to main content
SpringerLink
Log in

Cerebral Malaria

Optimising Management

  • Therapy In Practice
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

Cerebral malaria is one of the most common nontraumatic encephalopathies in the world. Children living in sub-Saharan Africa bear the brunt of the disease, but cerebral malaria is being seen increasingly in adults throughout the world, including outside malarious areas. There are differences in the clinical presentation and pathophysiology between African children and nonimmune adults from any region. Mortality is high (10–20%).

Parenteral antimalarials are the only interventions that have been shown to affect outcome. The cinchona alkaloids (quinine and quinidine) are the mainstay of antimalarial treatment, but the artemisinin derivatives are increasingly being used. Aggressive treatment and prevention of convulsions may be important, particularly in children. Other ancillary treatments that can be used to augment standard antimalarial drugs, such as exchange blood transfusions, osmotic diuretics and pentoxifylline, may improve outcome but have not been subjected to rigorous clinical trials. There is little support for corticosteroids or deferoxamine (desferrioxamine) in cerebral malaria. Other adjuncts have not been adequately tested.

Further research is required on drugs that interfere with the pathophysiological processes to prevent neurological complications and death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

References

  1. World health report 2001. Geneva: World Health Organization. 2001

  2. World Health Organization. Severe falciparum malaria. Trans R Soc Trop Med Hyg 2000; 94Suppl. 1: S1–S100

    Article  Google Scholar 

  3. Newton CR, Krishna S. Severe falciparum malaria in children: current understanding of pathophysiology and supportive treatment. Pharmacol Ther 1998; 79(1): 1–53

    Article  PubMed  CAS  Google Scholar 

  4. Newton CRJC, Hien TT, White NJ. Cerebral malaria. J Neurol Neurosurg Psychiatry 2000; 69: 433–41

    Article  PubMed  CAS  Google Scholar 

  5. Molyneux ME, Taylor TE, Wirima JJ, et al. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Q J Med 1989; 71: 441–59

    PubMed  CAS  Google Scholar 

  6. Brewster DR, Kwiatkowski D, White NJ. Neurological sequelae of cerebral malaria in children. Lancet 1990; 336: 1039–43

    Article  PubMed  CAS  Google Scholar 

  7. Bondi FS. The incidence and outcome of neurological abnormalities in childhood cerebral malaria: a long-term follow-up of 62 survivors. Trans R Soc Trop Med Hyg 1992; 86: 17–9

    Article  PubMed  CAS  Google Scholar 

  8. MacPherson G, Warrell MJ, White NJ. Human cerebral malaria: a quantitative ultrastructural analysis of parasitized erythrocyte sequestration. Am J Pathol 1985; 119: 385–401

    PubMed  CAS  Google Scholar 

  9. Brown H, Hien TT, Day N. Evidence of blood-brain barrier dysfunction in human cerebral malaria. Neuropathol Appl Neurobiol 1999; 25: 331–40

    Article  PubMed  CAS  Google Scholar 

  10. White NJ, Ho M. The pathophysiology of malaria. Adv Parasitai 1992; 31: 83–173

    Article  CAS  Google Scholar 

  11. Nash GB, Cooke BM, Marsh K, et al. Rheological analysis of the adhesive interactions of red blood cells parasitized by Plasmodium falciparum. Blood 1992; 79(3): 798–807

    PubMed  CAS  Google Scholar 

  12. Clark IA, Rockett KA, Cowden WB. Possible central role of nitric oxide in conditions clinically similar to cerebral malaria. Lancet 1992; 340(8824): 894–6

    Article  PubMed  CAS  Google Scholar 

  13. Kwiatkowski D, Hill A, Sambou I, et al. TNF concentration in fatal cerebral, non-fatal cerebral, and uncomplicated Plasmodium falciparum malaria. Lancet 1990; 336(8725): 1201–4

    Article  PubMed  CAS  Google Scholar 

  14. Treutiger C, Hedlund I, Helmby H, et al. Rosette formation in Plasmodium falciparum isolates and anti-rosette activity of sera from Gambians with cerebral or uncomplicated malaria. Am J Trop Med Hyg 1992; 46(5): 503–10

    PubMed  CAS  Google Scholar 

  15. Cranston HA, Boylan CW, Carroll GL, et al. Plasmodium falciparum maturation abolishes physiologic red cell deformability. Science 1984; 223: 400–3

    Article  PubMed  CAS  Google Scholar 

  16. Dondorp A, Kager P, Vreeken J, et al. Abnormal blood flow and red cell deformability in severe malaria. Parasitol Today 2000; 16(6): 228–32

    Article  PubMed  CAS  Google Scholar 

  17. White VA, Lewallen S, Beare N, et al. Correlation of retinal haemorrhages with brain haemorrhages in children dying of cerebral malaria in Malawi. Trans R Soc Trop Med Hyg 2001 Nov–Dec; 95(6): 618–21

    Article  PubMed  CAS  Google Scholar 

  18. Newton C, Kirkham F, Winstanley P, et al. Intracranial pressure in African children with cerebral malaria. Lancet 1991; 337(8741): 573–6

    Article  PubMed  CAS  Google Scholar 

  19. Newton C, Crawley J, Sowumni A, et al. Intracranial hypertension in Africans with cerebral malaria. Arch Dis Child 1997; 76: 219–26

    Article  PubMed  CAS  Google Scholar 

  20. Holding PA, Stevenson J, Peshu N, et al. Cognitive sequelae of severe malaria with impaired consciousness. Trans R Soc Trop Med Hyg 1999; 93(5): 529–34

    Article  PubMed  CAS  Google Scholar 

  21. Sowunmi A. Psychosis after cerebral malaria in children. J Natl Med Assoc 1993; 85(9): 695–6

    PubMed  CAS  Google Scholar 

  22. Looareesuwan S, Warrell DA, White NJ, et al. Retinal haemorrhage, a common physical sign of prognostic significance in cerebral malaria. Am J Trop Med Hyg 1983; 32: 911–5

    PubMed  CAS  Google Scholar 

  23. White NJ, Warrell DA, Chanthavanich P, et al. Severe hypoglycemia and hyperinsulinemia in falciparum malaria. N Engl J Med 1983 Jul 14; 309(2): 61–6

    Article  PubMed  CAS  Google Scholar 

  24. Trang TT, Phu NH, Vinh H, et al. Acute renal failure in patients with severe falciparum malaria. Clin Infect Dis 1992; 15(5): 874–80

    Article  PubMed  CAS  Google Scholar 

  25. Nguyen TH, Day NP, Ly VC, et al. Post-malaria neurological syndrome. Lancet 1996 Oct 5; 348(9032): 917–21

    Article  PubMed  CAS  Google Scholar 

  26. Looareesuwan S, Phillips RE, White NJ, et al. Quinine and severe falciparum malaria in late pregnancy. Lancet 1985; II: 4–8

    Article  Google Scholar 

  27. Moody A. Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev 2002 Jan; 15(1): 66–78

    Article  PubMed  CAS  Google Scholar 

  28. Warrell DA. Cerebral malaria. Schweiz Med Wochenschr 1992; 122: 879–86

    PubMed  CAS  Google Scholar 

  29. White NJ, Looareesuwan S, Warrell D, et al. Quinine loading dose in cerebral malaria. Am J Trop Med Hyg 1983; 32: 1–5

    PubMed  CAS  Google Scholar 

  30. Pasvol G, Newton CR, Winstanley PA, et al. Quinine treatment of severe falciparum malaria in African children: a randomized comparison of three regimens. Am J Trop Med Hyg 1991; 45: 702–13

    PubMed  CAS  Google Scholar 

  31. Winstanley PA, Mberu E, Watkins WM, et al. Towards optimal regimens of parenteral quinine for young African children with cerebral malaria: unbound quinine concentrations following a simple loading dose regimen. Trans R Soc Trop Med Hyg 1994; 88: 577–80

    Article  PubMed  CAS  Google Scholar 

  32. Davis TM, Supanaranond W, Pukrittayakamee S, et al. A safe and effective consecutive-infusion regimen for rapid quinine loading in severe falciparum malaria. J Infect Dis 1990; 161: 1305–8

    Article  PubMed  CAS  Google Scholar 

  33. Phillips RE, Warrell DA, White NJ. Intravenous quinidine for the treatment of severe falciparum malaria: clinical and pharmacokinetic studies. N Engl J Med 1985; 312: 1273–8

    Article  PubMed  CAS  Google Scholar 

  34. Miller KD, Greenberg AE, Campbell CC. Treatment of severe malaria in the United States with continuous infusions of quinidine gluconate and exchange transfusion. N Engl J Med 1989; 321: 65–70

    Article  PubMed  CAS  Google Scholar 

  35. Nealon C, Dzeing A, Muller-Romer U, et al. Intramuscular bioavailability and clinical efficacy of artesunate in Gabonese children with severe malaria. Antimicrob Agents Chemother 2002 Dec; 46(12): 3933–9

    Article  PubMed  CAS  Google Scholar 

  36. Murphy SA, Mberu E, Muhia D, et al. The disposition of intramuscular artemether in children with cerebral malaria: a preliminary study. Trans R Soc Trop Med Hyg 1997; 91: 331–4

    Article  PubMed  CAS  Google Scholar 

  37. Winstanley P, Newton C, Watkins W, et al. Towards optimal regimens or parenteral quinine for young African children with cerebral malaria: the importance of unbound quinine concentration. Trans R Soc Trop Med Hyg 1993; 87: 201–6

    Article  PubMed  CAS  Google Scholar 

  38. van Hensbroek MB, Onyiorah E, Jaffar S, et al. A trial of artemether or quinine in children with cerebral malaria. N Engl J Med 1996; 335(2): 69–75

    Article  PubMed  Google Scholar 

  39. Silamut K, Molunto P, Ho M, et al. Alpha 1-acid glycoprotein (orosomucoid) and plasma protein binding of quinine in falciparum malaria. Br J Clin Pharmacol 1991; 32(3): 311–5

    Article  PubMed  CAS  Google Scholar 

  40. White N, Looareesuwan S, Warrell D, et al. Quinine pharmacokinetics and toxicity in cerebral and uncomplicated falciparum malaria. Am J Med 1982; 73(4): 564–72

    Article  PubMed  CAS  Google Scholar 

  41. Silamut K, White NJ, Looareesuwan S, et al. Binding of quinine to plasma proteins in falciparum malaria. Am J Trop Med Hyg 1985; 24: 681–6

    Google Scholar 

  42. Barennes H, Kahiatani F, Pussard E, et al. Intrarectal Quinimax (an association of Cinchona alkaloids) for the treatment of Plasmodium falciparum malaria in children in Niger: efficacy and pharmacokinetics. Trans R Soc Trop Med Hyg 1995; 89(4): 418–21

    Article  PubMed  CAS  Google Scholar 

  43. Barennes H, Munjakazi J, Verdier F, et al. An open randomized clinical study of intrarectal versus infused Quinimax for the treatment of childhood cerebral malaria in Niger. Trans R Soc Trop Med Hyg 1998; 92(4): 437–40

    Article  PubMed  CAS  Google Scholar 

  44. Murphy S, English M, Omar A, et al. The management of severe malaria in children: a review. East Afr Med J 1995; 72(8): 536–9

    PubMed  CAS  Google Scholar 

  45. Athan E, Durrheim D, Barnes K, et al. Effectiveness of short-course quinine and single-dose sulfadoxine-pyrimethamine in the treatment of Plasmodium falciparum malaria in Mpumalanga Province, South Africa. S Afr Med J 2001; 91(7): 592–4

    PubMed  CAS  Google Scholar 

  46. White N, Looareesuwan S, Warrell D, et al. Quinidine in falciparum malaria. Lancet 1981; II(8255): 1069–71

    Article  Google Scholar 

  47. Warrell DA. Treatment of severe malaria. J R Soc Med 1989; 82(17): 44–50

    PubMed  Google Scholar 

  48. White NJ. The treatment of malaria. N Engl J Med 1996; 341: 800–6

    Article  Google Scholar 

  49. Phillips RE, Looareesuwan S, White NJ, et al. Quinine pharmacokinetics and toxicity in pregnant and lactating women with falciparum malaria. Br J Clin Pharmacol 1986; 21: 677–83

    Article  PubMed  CAS  Google Scholar 

  50. Tran TH, Day NP, Nguyen HP, et al. A controlled trial of artemether or quinine in Vietnamese adults with severe falciparum malaria. N Engl J Med 1996; 335: 76–83

    Article  PubMed  CAS  Google Scholar 

  51. Murphy S, English M, Waruiru C, et al. An open randomized trial of artemether versus quinine in the treatment of cerebral malaria in African children. Trans R Soc Trop Med Hyg 1996; 90: 298–301

    Article  PubMed  CAS  Google Scholar 

  52. Taylor TE, Wills BA, Courval JM, et al. Intramuscular artemether vs intravenous quinine: an open, randomized trial in Malawian children with cerebral malaria. Trop Med Int Health 1998; 3(8): 3–8

    Article  PubMed  CAS  Google Scholar 

  53. Mclntosh HM, Olliaro P. Artemisinin derivatives for treating severe malaria. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Update Software, 2000

    Google Scholar 

  54. Hien TT, Day NPJ, Phu NH, et al. Controlled trial of artemether or quinine in Vietnamese adults with severe falciparum malaria. N Engl J Med 1996; 335: 76–83

    Article  CAS  Google Scholar 

  55. Phuong CXT, Bethell DB, Phoung PT, et al. Comparison of artemisinin suppositories, intramuscular artesunate and intravenous quinine for the treatment of severe childhood malaria. Trans R Soc Trop Med Hyg 1997; 91: 335–42

    Article  CAS  Google Scholar 

  56. Krishna S, Planche T, Agbenyega T, et al. Bioavailability and preliminary clinical efficacy of intrarectal artesunate in Ghanaian children with moderate malaria. Antimicrob Agents Chemother 2001; 45(2): 509–16

    Article  PubMed  CAS  Google Scholar 

  57. Dayan A. Neurotoxicity and artemisinin compounds do the observations in animals justify limitation of clinical use? Med Trop (Mars) 1998; 58(3 Suppl.): 32–7

    CAS  Google Scholar 

  58. Brewer TG, Grate SJ, Peggins JO, et al. Fatal neurotoxicity of arteether and artemether. Am J Trop Med Hyg 1994; 51(3): 251–9

    PubMed  CAS  Google Scholar 

  59. Brewer TG, Peggins JO, Grate SJ, et al. Neurotoxicity in animals due to arteether and artemether. Trans R Soc Trop Med Hyg 1994; 88Suppl. 1: S33–6

    Article  PubMed  Google Scholar 

  60. Asindi AA, Ekanem EE, Ibia EO, et al. Upsurge of malaria-related convulsions in a paediatric emergency room in Nigeria: consequence of emergence of chloroquine-resistant Plasmodium falciparum. Trop Geogr Med 1993; 45(3): 110–3

    PubMed  CAS  Google Scholar 

  61. Waruiru CM, Newton CR, Forster D, et al. Epileptic seizures and malaria in Kenyan children. Trans R Soc Trop Med Hyg 1996; 90(2): 152–5

    Article  PubMed  CAS  Google Scholar 

  62. Wattanagoon Y, Srivilairit S, Looareesuwan S, et al. Convulsions in childhood malaria. Trans R Soc Trop Med Hyg 1994; 88(4): 426–8

    Article  PubMed  CAS  Google Scholar 

  63. Crawley J, Smith S, Kirkham F, et al. Scizures and status epilepticus in childhood cerebral malaria. QJM 1996; 89(8): 591–7

    Article  PubMed  CAS  Google Scholar 

  64. Akpede GO, Sykes RM, Abiodun PO. Convulsions with malaria: febrile or indicative of cerebral involvement? J Trop Pediatr 1993; 39(6): 350–5

    Article  PubMed  CAS  Google Scholar 

  65. White NJ, Looareesuwan S, Phillips RE, et al. Single dose phenobarbitone prevents convulsions in cerebral malaria. Lancet 1988; II(8602): 64–6

    Article  Google Scholar 

  66. Winstanley PA, Newton CR, Pasvol G, et al. Prophylactic phenobarbitone in young children with severe falciparum malaria: pharmacokinetics and clinical effects. Br J Clin Pharmacol 1992; 33: 149–54

    Article  PubMed  CAS  Google Scholar 

  67. Crawley J, Waruiru C, Mithwani S, et al. Phenobarbitone halves the seizure frequency, but doubles mortality in childhood cerebral malaria: results of a double blind, randomised controlled trial. Lancet 2000; 26(355): 701–6

    Article  Google Scholar 

  68. Ogutu BR, Newton CR, Muchohi SN, et al. Phenytoin pharmacokinetics and clinical effects in African children following fosphenytoin and chloramphenicol co-administration. Br J Clin Pharmacol 2002; 54: 635–42

    PubMed  CAS  Google Scholar 

  69. Tasker RC. Emergency treatment of acute seizures and status epilepticus. Arch Dis Child 1998; 79(1): 78–83

    Article  PubMed  CAS  Google Scholar 

  70. Ogutu BR, Newton CR, Crawley J, et al. Pharmacokinetics of diazepam in children with severe falciparum malaria and convulsions. Br J Clin Pharmacol 2002; 53(1): 49–58

    Article  PubMed  CAS  Google Scholar 

  71. Shorvon S. Emergency treatment of status epilepticus. Cambridge: Cambridge University Press, 1994

    Book  Google Scholar 

  72. Scott RC, Besag FM, Boyd SG, et al. Buccal absorption of midazolam: pharmacokinetics and EEG pharmacodynamics. Epilepsia 1998; 39(3): 290–4

    Article  PubMed  CAS  Google Scholar 

  73. Scott RC, Besag FM, Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 1999; 353(9153): 623–6

    Article  PubMed  CAS  Google Scholar 

  74. Lockman L. Other antiepileptic drugs: paraldehyde. In: Levy R, Matson H, Meldrum BS, editors. Antiepileptic drugs. New York: Raven Press, 1995: 963–7

    Google Scholar 

  75. Kokwaro GO, Ogutu B, Muchochi SN, et al. Pharmacokinetics and clinical effect of phenobarbitone in children with severe falciprum malaria and convulsions. Br J Clin Pharmacol. In press

  76. Boucher BA. Fosphenytoin: a novel phenytoin prodrug. Pharmacotherapy 1996; 16(5): 777–91

    PubMed  CAS  Google Scholar 

  77. Mirski MA, Williams MA, Hanley DF. Prolonged pentobarbital and phenobarbital coma for refractory generalized status epilepticus. Crit Care Med 1995; 23(2): 400–4

    Article  PubMed  CAS  Google Scholar 

  78. Wilkinson RJ, Brown JL, Pasvol G, et al. Severe falciparum malaria: predicting the effect of exchange transfusion. Q J Med 1994; 87: 553–7

    CAS  Google Scholar 

  79. Looareesuwan S, Phillips RE, Karbwang J, et al. Plasmodium falciparum hyperparasitaemia: use of exchange transfusion in seven patients and a review of the literature. Q J Med 1990; 75: 471–81

    PubMed  CAS  Google Scholar 

  80. Riddle MS, Jackson JL, Sanders JW, et al. Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a meta-analysis. Clin Infect Dis 2002; 34(9): 1192–8

    Article  PubMed  Google Scholar 

  81. Lell B, Sovric M, Schmid D, et al. Effect of antipyretic drugs in children with malaria. Clin Infect Dis 2001; 32(5): 838–41

    Article  PubMed  CAS  Google Scholar 

  82. Brandts C, Ndjave M, Graninger W, et al. Effect of paracetamol on parasite clearance time in Plasmodium falciparum malaria. Lancet 1997; 350(9079): 704–9

    Article  PubMed  CAS  Google Scholar 

  83. Krishna S, Supanaranond W, Pukrittayakamee S, et al. Fever in uncomplicated Plasmodium falciparum infection: effects of quinine and paracetamol. Trans R Soc Trop Med Hyg 1995 Mar–Apr; 89(2): 197–9

    Article  PubMed  CAS  Google Scholar 

  84. Krishna S, Pukrittayakamee S, Supanaranond W, et al. Fever in uncomplicated Plasmodium falciparum malaria: randomised double-‘blind’ comparison of ibuprofen and paracetamol treatment. Trans R Soc Trop Med Hyg 1995; 89: 507–9

    Article  PubMed  CAS  Google Scholar 

  85. Warrell DA, Looareesuwan S, Warrell MJ, et al. Dexamethasone proves deleterious in cerebral malaria: a double-blind trial in 100 comatose patients. N Engl J Med 1982; 306: 313–9

    Article  PubMed  CAS  Google Scholar 

  86. Hoffman SL, Rustama D, Punjabi NH. High-dose dexamethasone in quinine-treated patients with cerebral malaria: a double blind placebo controlled trial. J Infect Dis 1988; 158: 325–31

    Article  PubMed  CAS  Google Scholar 

  87. Di Perri G, Di Perri IG, Monteiro GB, et al. Pentoxifylline as a supportive agent in the treatment of cerebral malaria in children. J Infect Dis 1995; 171: 1317–22

    Article  PubMed  Google Scholar 

  88. Hemmer C, Hort G, Chiwakata C, et al. Supportive pentoxifylline in falciparum malaria: no effect on tumor necrosis factor alpha levels or clinical outcome: a prospective, randomized, placebo-controlled study. Am J Trop Med Hyg 1997; 56(4): 397–403

    PubMed  CAS  Google Scholar 

  89. Looareesuwan S, Wilairatana P, Vannaphan S, et al. Pentoxifylline as ancillary treatment in severe falciparum malaria in Thailand. Am J Trop Med Hyg 1998; 58: 348–53

    PubMed  CAS  Google Scholar 

  90. Thuma PE, Mabeza GF, Biemba G, et al. Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria. Trans R Soc Trop Med Hyg 1998; 92: 214–8

    Article  PubMed  CAS  Google Scholar 

  91. Van der Torn M, Thuma PE, Mabeza GF, et al. Loading dose of quinine in African children with cerebral malaria. Trans R Soc Trop Med Hyg 1998; 92: 325–31

    Article  PubMed  Google Scholar 

  92. Berkley J, Mwarumba S, Bramham K, et al. Bacteraemia complicating severe malaria in children. Trans R Soc Trop Med Hyg 1999; 93(3): 283–6

    Article  PubMed  CAS  Google Scholar 

  93. McGready R, Cho T, Keo NK, et al. Artemisinin antimalarials in pregnancy: a prospective treatment study of 539 episodes of multidrug-resistant Plasmodium falciparum. Clin Infect Dis 2001; 33(12): 2009–16

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This publication is made with the permission of the Director of the Kenya Medical Research Institute (KEMRI). All of the authors were funded by the Wellcome Trust UK, and Dr Ogutu had additional support from the WHO. Dr Newton is a Wellcome Trust Senior Clinical Research Fellow (grant no. 050533).

Author information

Authors and Affiliations

  1. Centre for Geographic Medicine Research, Coast, Kenya Medical Research Institute (KEMRI), PO Box 230, Kilifi, Kenya

    Neema Mturi, Crispin O. Musumba, Betty M. Wamola, Bernhards R. Ogutu &  Charles R. J. C. Newton

  2. KEMRI Centre for Clinical Research, Nairobi, Kenya

    Bernhards R. Ogutu

  3. Neurosciences Unit, Institute of Child Health, London, UK

    Charles R. J. C. Newton

Authors
  1. Neema Mturi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Crispin O. Musumba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Betty M. Wamola
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernhards R. Ogutu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles R. J. C. Newton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles R. J. C. Newton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mturi, N., Musumba, C.O., Wamola, B.M. et al. Cerebral Malaria. CNS Drugs 17, 153–166 (2003). https://doi.org/10.2165/00023210-200317030-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-200317030-00002

Keywords

Search

Navigation