Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  12 (2023)
Volume  11 (2022)
Volume  10 (2021)
Volume  9 (2020)
Volume  8 (2019)
Volume  7 (2018)
Volume  6 (2017)
Volume  5 (2016)
Volume  4 (2015)
Volume  3 (2014)
Volume  2 (2013)
Volume  1 (2012)
Related articles

VOLUME 10 , ISSUE 3 ( September-December, 2021 ) > List of Articles

CASE REPORT

Patient with Severe Traumatic Brain Injury and Malaria in a Middle Eastern Country

Amani NH Alansari, Suresh Arumugam

Keywords : Falciparum, Ischemia, Malaria, Pathophysiological mechanism, Traumatic brain injury, Traumatic subdural hematoma

Citation Information : Alansari AN, Arumugam S. Patient with Severe Traumatic Brain Injury and Malaria in a Middle Eastern Country. Panam J Trauma Crit Care Emerg Surg 2021; 10 (3):134-138.

DOI: 10.5005/jp-journals-10030-1363

License: CC BY-NC 4.0

Published Online: 18-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim and objective: This manuscript reports a case of severe traumatic brain injury in a patient complicated by Falciparum malaria with review of the literature and discussion of possible underlying mechanism aggravating the secondary brain injury. Background: Plasmodium falciparum (P. falciparum) malaria accounts for more than 90% of deaths caused by malaria in the world. Parasitized red blood cells sequester and cause capillary occlusion, endothelial damage, cytokine activation, and dysregulation of coagulation leading to exacerbation of secondary injury after traumatic brain injury. Case description: The case reports highlight a rare case of 38-year-old patient admitted after traumatic brain injury with rapid deterioration. Patient was found to have P. falciparum malaria with 3.9% parasitised RBC. CT head revealed a large right sided subdural haemato-hygroma, midline shift and ischemia in the right posterior cerebral artery territory. Despite timely intervention and evacuation of subdural haematoma, patient had a poor outcome with multiple infarcts, hemorrhagic transformation, and early hydrocephalus. Patient remains in a vegetative state in a long-term unit. Conclusion: Combined effect of endothelial, microcirculatory, inflammatory, and clotting dysfunction caused by traumatic brain injury and parasitaemia leading to aggravation of secondary brain injury. Clinical significance: This case report highlights the intricate relationship between endothelial, inflammatory, and coagulation cascade triggered after brain injury. The nature of coagulopathy in such patients is complex with state of hypo-coagulation early followed by a hyper-coagulatory state in the late phase.

HTML PDF Share
  1. El-Menyar A, Consunji R, Al-Thani H. Handbook of Healthcare in the Arab World. Published online 2021:2469–2482. DOI: 10.1007/978-3-030-36811-1_106
  2. World Malaria Report. https://www.who.int/publications/i/item/9789240015791
  3. Newton CRJC, Hien TT, White N. Cerebral malaria. J Neurology Neurosurg Psychiatry 2000;69(4):433–441. DOI: 10.1136/jnnp.69.4.433
  4. Idro R, Jenkins NE, Newton CR. Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol 2005;4(12):827–840. DOI: 10.1016/s1474–4422(05)70247–7
  5. Moxon CA, Heyderman RS, Wassmer SC. Dysregulation of coagulation in cerebral malaria. Mol Biochem Parasitol 2009;166(2):99–108. DOI: 10.1016/j.molbiopara.2009.03.006
  6. Severe falciparum malaria. World Health OrganizationT Roy Soc Trop Med H Communicable Diseases Cluster. 2000;94 Suppl 1:S1–90.
  7. Afandi D, Sampurna B, Sutanto I, et al. Autopsy findings in severe wmalaria – a case report. Medical J Indonesia 2008;17(3):210–215. DOI: 10.13181/mji.v17i3.315
  8. Karanth SS, Marupudi KC, Gupta A. Intracerebral bleed, right haemiparesis and seizures: an atypical presentation of vivax malaria. Bmj Case Rep 2014;2014:bcr2014204833. DOI: 10.1136/bcr–2014–204833
  9. SenthilKumaran S, Balamurugan N, Suresh P, et al. Extradural hematoma in plasmodium vivax malaria: are we alert to detect? J Neurosci Rural Pract 2013;4(Suppl 1):S145-S146. DOI: 10.4103/0976–3147.116476
  10. Dwarakanath S, Suri A, Mahapatra AK. Spontaneous subdural empyema in falciparum malaria: a case study. J Vector Dis 2004; 41(3–4):80–82.
  11. Murugavel K, Saravanapavananthan S, Anpalahan A, et al. Subarachnoid haemorrhage in plasmodium falciparum malaria. Postgrad Med J 1989;65(762):236–237.
  12. Gall C, Spuler A, Fraunberger P. Subarachnoid hemorrhage in a patient with cerebral malaria. New Engl J Med 1999;341(8):611–613. DOI: 10.1056/nejm199908193410814
  13. Seshadri P, Dev AV, Viggeswarpu S, et al. Acute pancreatitis and subdural haematoma in a patient with severe falciparum malaria: case report and review of literature. Malaria J 2008;7(1):97–97. DOI: 10.1186/1475-2875-7-97
  14. Patankar TF, Karnad DR, Shetty PG, et al. Adult cerebral malaria: prognostic importance of imaging findings and correlation with postmortem findings. Radiology 2002;224(3):811–816. DOI: 10.1148/radiol.2243010588
  15. Hunt NH, Grau GE. Cytokines: accelerators and brakes in the pathogenesis of cerebral malaria. Trends Immunol 2003;24(9):491–499. DOI: 10.1016/s1471–4906(03)00229–1
  16. Kelton JG, Keystone J, Moore J, et al. Immune-mediated thrombocytopenia of malaria. J Clin Invest 1983;71(4):832–836. DOI: 10.1172/jci110836
  17. Pongponratn E, Riganti M, Harinasuta T, et al. Electron microscopy of the human brain in cerebral malaria. Southeast Asian J Tropical Medicine Public Health 1985;16(2):219–227.
  18. Grau GE, Mackenzie CD, Carr RA, et al. Platelet accumulation in brain microvessels in fatal pediatric cerebral malaria. J Infect Dis 2003;187(3):461–466. DOI: 10.1086/367960
  19. Pino P, Vouldoukis I, Kolb JP, et al. Plasmodium falciparum–infected erythrocyte adhesion induces caspase activation and apoptosis in human endothelial cells. J Infect Dis 2003;187(8):1283–1290. DOI: 10.1086/373992
  20. Laroche M, Kutcher ME, Huang MC, et al. Coagulopathy after traumatic brain injury. Neurosurgery 2012;70(6):1334–1345. DOI: 10.1227/neu.0b013e31824d179b
  21. CRASH-3 trial Collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019;394(10210):1713–1723. DOI: 10.1016/s0140–6736(19)32233–0
  22. Monson KL, Converse MI, Manley GT. Cerebral blood vessel damage in traumatic brain injury. Clin Biomech (Bristol, Avon) 2019;64:98–113. DOI: 10.1016/j.clinbiomech.2018.02.011
  23. Kushimoto S, Shibata Y, Yamamoto Y. Implications of fibrinogenolysis in patients with closed head injury. J Neurotraum 2003;20(4):357–363. DOI: 10.1089/089771503765172318
  24. Zhang J, He M, Song Y, Xu J. Prognostic role of D-dimer level upon admission in patients with traumatic brain injury. Medicine (Baltimore) 2018;97(31):e11774. DOI: 10.1097/md.0000000000011774
  25. Server A, Dullerud R, Haakonsen M, et al. Post-traumatic cerebral infaction. Neuroimaging findings, etiology and outcome. Acta Radiol 2001;42(3):254–260.
  26. Ikushima I, Korogi Y, Kitajima M, et al. Evaluation of drainage patterns of the major anastomotic veins on the lateral surface of the cerebrum using three-dimensional contrast-enhanced MP-RAGE sequence. Eur J Radiol 2006;58(1):96–101. DOI: 10.1016/j.ejrad.2005.11.011
  27. Mageid R, Ding Y, Fu P. Vein of Labbe thrombosis, a near-miss. Brain Circ 2018;4(4):188–190. DOI: 10.4103/bc.bc_34_18
  28. Munakomi S, Kumar B. Case report: traumatic vein of Labbé hemorrhagic infarction - a distinct neurosurgical entity. F1000research 2015;4:586. DOI: 10.12688/f1000research.6910.1
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.