Idro et al. BMC Research Notes 2010, 3:104 http://www.biomedcentral.com/1756-0500/3/104 Open Access SHORT REPORT BioMed Central © 2010 Idro et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons At- tribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Short Report Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children Richard Idro* 1 , Angelina Kakooza-Mwesige 1 , Stephen Balyejjussa 1 , Grace Mirembe 1 , Christine Mugasha 1 , Joshua Tugumisirize 2 and Justus Byarugaba 1 Abstract Background: Cerebral malaria is the most severe neurological complication of falciparum malaria and a leading cause of death and neuro-disability in sub-Saharan Africa. This study aimed to describe functional deficits and behaviour problems in children who survived cerebral malaria with severe neurological sequelae and identify patterns of brain injury. Findings: Records of children attending a specialist child neurology clinic in Uganda with severe neurological sequelae following cerebral malaria between January 2007 and December 2008 were examined to describe deficits in gross motor function, speech, vision and hearing, behaviour problems or epilepsy. Deficits were classified according to the time of development and whether their distribution suggested a focal or generalized injury. Any resolution during the observation period was also documented. Thirty children with probable exposure to cerebral malaria attended the clinic. Referral information was inadequate to exclude other diagnoses in 7 children and these were excluded. In the remaining 23 patients, the commonest severe deficits were spastic motor weakness (14), loss of speech (14), hearing deficit (9), behaviour problems (11), epilepsy (12), blindness (12) and severe cognitive impairment (9). Behaviour problems included hyperactivity, impulsiveness and inattentiveness as in attention deficit hyperactivity disorder (ADHD) and conduct disorders with aggressive, self injurious or destructive behaviour. Two patterns were observed; a) immediate onset deficits present on discharge and b) late onset deficits. Some deficits e.g. blindness, resolved within 6 months while others e.g. speech, showed little improvement over the 6-months follow-up. Conclusions: In addition to previously described neurological and cognitive sequelae, severe behaviour problems may follow cerebral malaria in children. The observed differences in patterns of sequelae may be due to different pathogenic mechanisms, brain regions affected or extent of injury. Cerebral malaria may be used as a new model to study the pathogenesis of ADHD. Background Cerebral malaria is the most severe neurological compli- cation of falciparum malaria. Children with cerebral malaria are admitted with fever, seizures, coma and brainstem signs and despite adequate treatment using current guidelines, about 20% die[1]. Earlier studies sug- gested that there is full neurological recovery[2] but over the past 15 years, it has become increasingly clear that many children sustain severe brain injury after cerebral malaria and 25% have long-term neurological and cogni- tive deficits or epilepsy [3-8]. Thus, cerebral malaria is now considered a leading cause of neuro-disability in sub-Saharan Africa[9]. A wide range of functional deficits are described [3-7], the incidence of some of which increase with time[5]. However, the understanding of the pathogenesis of brain injury is poor. Observational studies have identified repeated and prolonged seizures, intracranial hyperten- * Correspondence: ridro1@gmail.com 1 Department of Paediatrics and Child Health, Mulago Hospital and Makerere University School of Medicine, PO Box 7072, Kampala, Uganda Full list of author information is available at the end of the article