Introduction

Malaria remains a leading cause of illness and mortality worldwide, especially in sub-Saharan Africa. Despite extensive global efforts to combat this disease, it continues to pose a significant public health challenge. A recent case from Ethiopia has brought attention to a rare but severe complication of malaria: a hemorrhagic stroke. This report highlights the unusual case of a 26-year-old male who suffered this serious condition, underscoring the grave consequences malaria can have on neurological health.

Case Presentation

The patient, a 26-year-old male from southwest Ethiopia, was brought to the hospital with a concerning loss of consciousness lasting 12 hours. Just three days earlier, he experienced high fever, severe headache, vomiting, chills, and shivering. On examination, his vital signs revealed a rapid pulse of 116 beats per minute, a blood pressure of 120/90 mmHg, and a high temperature of 38.9°C. Nervously, he was found to be stuporous with a Glasgow Coma Scale score of 10 out of 15.

Diagnostic tests revealed a Plasmodium falciparum infection, confirmed through blood films and rapid diagnostic tests (RDTs). A non-contrast CT scan indicated a right cerebral parenchymal hemorrhage, a type of stroke characterized by bleeding within the brain tissue.

Discussion and Implications

This case stands out as it highlights the serious neurological complications associated with severe malaria. The patient developed left-side hemiparesis—weakness affecting the left side of his body—likely due to the hemorrhagic stroke linked to the cerebral impact of malaria. It is crucial for healthcare providers in malaria-endemic regions to consider stroke as a potential complication in patients presenting with body weakness.

Malaria is caused by the Plasmodium parasite, primarily transmitted through infected Anopheles mosquitoes. Plasmodium falciparum accounts for more than 99% of malaria-related fatalities globally. Although primarily recognized for causing uncomplicated malaria, there is an increasing body of evidence suggesting that all species of Plasmodium, including P. vivax, can lead to severe complications in certain circumstances.

The World Health Organization defines cerebral malaria as a severe form characterized by impaired consciousness and asexual forms of the P. falciparum parasite on blood smears. It remains a critical condition with a high mortality rate if not promptly and adequately treated.

Management and Recovery

After the initial diagnosis, the patient’s condition deteriorated, necessitating intubation and a mechanical ventilator due to rising intracranial pressure and the development of aspiration pneumonia. He received treatment with artesunate and broad-spectrum antibiotics while being monitored in the Intensive Care Unit. Remarkably, after several days, he regained consciousness and was able to eat independently.

Despite showing signs of recovery, the patient continued to experience left-sided weakness upon discharge, highlighting the long-term challenges that may follow such severe cases of malaria. The case illustrates the need for thorough follow-up and rehabilitation, including physiotherapy support to address enduring motor deficits.

Conclusion

This rare case of hemorrhagic stroke following malaria serves as an alarming reminder of the disease’s severe implications. It emphasizes the necessity for heightened awareness among healthcare providers in endemic areas about the potential neurological complications of malaria. Rapid diagnosis and treatment remain crucial in managing such scenarios and improving patient outcomes.

As the global fight against malaria progresses, understanding and preventing severe complications like stroke should be an integral component of comprehensive malaria management. Further research is essential to explore the mechanisms behind such debilitating outcomes and to refine treatment protocols. Malaria is more than just a fever; it can have life-altering consequences for young and healthy individuals.