Malaria is a leading cause of global mortality and morbidity from infectious disease. The classical neurological sequelae from direct CNS invasion are often fulminant and well recognised. Only in recent times however has there been growing appreciation of a central neurological syndrome which emerges in the post infectious phase following effective treatment and clearance of parasitaemia. This is a heterogenous entity characterised by psychomotor disturbance in keeping with encephalopathy, focal signs and other neurological phenomena. In the context of more extensive world travel, recognition of this disorder is likely to become increasingly important. We present the case of a man who experienced a biphasic neurological illness that developed 2 weeks after recovery from Plasmodium falciparum malaria acquired in The Gambia. His psychotic manifestations, cognitive impairment and opthalmoplegia appeared sub acutely following eradication of parasitaemia and were fluctuant. He was extensively investigated for a wide differential without yield, and displayed a steady and complete spontaneous resolution. His clinical picture is in keeping with case series from the global literature on the clinical entity described as Post Malarial Neurological Syndrome. Here we speculate on the current thinking regarding aetiology and suggest a rational approach to treatment if needed.
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