Chronic subdural hemorrhage as a rare complication of Plasmodium knowlesi malaria: A case report

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Siti Nur Hajar Mohd Zain, Mohamad Hidir Abdullah, Ling Jyh Chyang and Ng Wei Chih

Sibu Hospital, Malaysia

: J Spine Neurosurg

Abstract

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Nearly half of the world’s population is at risk of Malaria with nearly half a million deaths each year. Plasmodium knowlesi was found to be the most prevalent cause of malaria unique in Malaysian Borneo. Severe malaria infection has known to cause many fatal systemic complications, but subdural hematoma has rarely been reported. We are reporting a first case of spontaneous Subdural Hematoma (SDH) linked to Plasmodium knowlesi malaria in Malaysia. A 35 years old man presented with an episode of unprovoked generalized tonic clonic seizure with intermittent headache for a week. He was diagnosed with Plasmodium knowlesi malaria three weeks prior, treated with chloroquine and subsequently discharged from Medical Ward. At current presentation there was no altered sensorium, both pupils were equal and reactive to light, afebrile and vital signs stable. Neurological examinations were unremarkable. Blood investigations during his previous admission illustrate bicytopenia (hemoglobin 5.8 g/dl, platelet 40x103/microliter) which has normalized during his recent encounter. A brain CT scan revealed a posterior inter-hemispheric subdural collection that is non-enhancing with contrast. MRI Brain is consistent with a sub-acute subdural hematoma. Repeated peripheral blood films were negative for plasmodium parasites. He was given phenytoin for seizures, whilst the SDH was being monitored closely. He was discharged well after three days of observation. A follow up CT scan at 1 month showed resolved SDH. In conclusion, formation of SDH could likely be explained by sequestration of parasitized red blood cells causing rupture of small vessels in association with severe thrombocytopenia. Acute SDH could present as a neurosurgical emergency. Intracranial hemorrhage should be suspected once neurological symptoms arise. Close neurological monitoring and early neurosurgical intervention could prevent severe morbidity and mortality resulting from intracranial hemorrhage.

Biography

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Siti Nur Hajar is a neurosurgery resident in Neurosurgery Department at Sibu Hospital, Sarawak, MALAYSIA. Graduated from Royal College of Medicine, Perak in 2015, she then begun her career as medical doctor at Seremban General Hospital where her interest in neurosurgical field grew. She has been to Cambodia to dedicate her time for humanitarian care in collaboration with Doctors Without Borders as to give check ups and services for those with limited medical access. During her residency in Sibu, she shows great interest in neuro-oncology and neuro-trauma field. She has assisted multiple cranial surgery caused by trauma as well as spinal surgeries.

E-mail: drhajarzain@gmail.com