Stroke incidence, presentation, and outcomes in malaria: a review of current evidence.
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Authors
Aderinto, Nicholas
Abraham, Israel Charles
Olatunji, Gbolahan
Kokori, Emmanuel
Babalola, Adetola Emmanuel
Gaur, Aditya
Babawale, Emmanuel Adeoba
Akinmeji, Olufemi
Alabi, Ayobami Oyetunji
Issue Date
2025-06-18
Type
Journal Article
Review
Review
Language
en
Keywords
Hemorrhagic stroke , Ischemic stroke , Malaria , Plasmodium falciparum , Plasmodium vivax , Stroke
Alternative Title
Abstract
Malaria, a global health challenge, remains a leading cause of morbidity and mortality, particularly in sub-Saharan Africa, Southeast Asia, and South America. While traditionally associated with fever and systemic complications, the neurological impact of malaria, including stroke, has become a significant concern. This review aims to examine the incidence, clinical presentation, and outcomes of stroke in individuals with malaria, highlighting the role of malaria in both ischaemic and haemorrhagic strokes. A literature search identified nine studies published between 1999 and 2024, comprising case reports and case series involving malaria-related strokes in patients aged 2 to 47 years. Most cases involved Plasmodium falciparum, with a notable association between this parasite and haemorrhagic strokes. Plasmodium vivax, while less commonly implicated, was associated with ischaemic strokes, especially in younger patients. Diagnostic challenges, including misdiagnosis, were frequently encountered due to the overlap of neurological symptoms with cerebral malaria, emphasizing the need for a high index of suspicion. The pathophysiology of malaria-related strokes is multifactorial, with both mechanical obstruction of cerebral vessels and hypercoagulable states contributing to stroke development. Treatment generally involves a combination of anti-malarial therapy and supportive care, including management of complications such as raised intracranial pressure or seizures. Outcomes vary, with ischaemic stroke patients showing better recovery than those with haemorrhagic strokes. However, mortality remains high, particularly in cases with severe complications like cerebral venous thrombosis. Early diagnosis and intervention are crucial for improving survival and minimizing long-term neurological impairment. Further research is needed to refine diagnostic approaches, elucidate the underlying mechanisms, and optimize management strategies for stroke in patients with malaria.
Description
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Citation
Aderinto, N. et al. (2025) 'Stroke incidence, presentation, and outcomes in malaria: a review of current evidence', Malaria Journal. 24(1): 193. Available at: https://doi.org/10.1186/s12936-025-05400-y
Publisher
BMC
License
© 2025. The Author(s).
Journal
Malaria journal
Volume
24
Issue
1
PubMed ID
ISSN
1475-2875