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Severe stridor and profound weakness after cerebral malaria
  1. Charlotte Fuller1,2,3,
  2. Gavin Wooldridge2,4,
  3. Alice Liomba2 and
  4. Stephen Thomas James Ray1,2,5,6
  1. 1Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
  2. 2Blantyre Malaria Project, Blantyre, Malawi
  3. 3Leeds Children’s Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
  4. 4Oxford Vaccine Group, University of Oxford, Oxford, UK
  5. 5Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
  6. 6National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Gavin Wooldridge; gfwooldridge{at}


Cerebral malaria (CM) is defined by WHO as coma (Blantyre Coma Score 2 or less) in a patient with Plasmodium falciparum parasitaemia and no alternative cause of coma identified. Mortality is approximately 15%–30% in African children and up to one-third of survivors have neurological sequelae. We present a patient with severe stridor and prolonged profound weakness during an intensive care admission with CM. These complications initially presented a diagnostic dilemma in our limited resourced setting. The stridor failed to improve with empiric steroids and a subsequent opportunistic ENT consult diagnosed vocal cord paresis. The weakness was so profound that the patient was unable to lift his head during the acute illness. The child received intensive physiotherapy, and at 1-month follow-up, the stridor and weakness had resolved.

  • global health
  • tropical medicine (infectious disease)
  • paediatric intensive care

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  • Correction notice This article has been corrected since it was published Online. The affiliations for all the authors have been corrected.

  • Contributors CF was responsible for manuscript conception. CF, GW and AL undertook the first draft of the manuscript. CF, GW, AL and STJR were involved in drafting and editing the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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