Two items in the review of cerebral malaria by Newtonet al 1 warrant comment. The first relates to corticosteroids in the treatment of cerebral malaria, and the second involves the definition of cerebral malaria.

The authors, citing Warrell et al 2 and Hoffman et al,3 stated that steroids are contraindicated in cerebral malaria because they add risks without providing any benefit.

In late December 1965, I arrived in Vietnam as a neurologist with the United States Army Medical Corps., and for the next 6 months I was the only neurologist serving United States forces in Vietnam. I was attached to the 93rd Evaluation Hospital, which opened only 2 weeks before my arrival. As recounted in a recent article about my Vietnam experience,4 two American soldiers with cerebral malaria died at the hospital during those 2 weeks, and the internal medicine specialists requested my involvement in all future cases. After reviewing the treatment protocols of the two soldiers, I decided that adding dexamethasone to the usual antimalarial regimen would be reasonable in patients with severe cerebral malaria. There was, I think, no literature at the time on the use of steroids; if there was, I certainly had no access to it in the combat zone.

During the next 10 months, we saw 19 patients with cerebral malaria, and they all recovered without any residual neurological dysfunction.5 Our success with steroids prompted all the United States medical units in Vietnam to adopt the practice. A decade after the end of the Vietnam conflict, Warrell et al,2 in a double blind …

Dr C R J C Newton cnewton{at}kilifi.mimcom.net

Dr C R J C Newton cnewton{at}kilifi.mimcom.net