Brain multimonitoring in a patient affected by severe cerebral malaria from Plasmodium falciparum: a case report

Background: Cerebral malaria (CM) is the most severe complication of Plasmodium falciparum infection, associated with cerebral edema, seizures, and high mortality. Optimizing cerebral hemodynamics is essential to improve outcomes.Case Report: We describe a 28-year-old man returning from Côte d’Ivoire who presented with a 4% parasitemia. Rapid deterioration required intensive care admission, mechanical ventilation, and intravenous artesunate. Multimodal neuromonitoring included continuous electroencephalography, intracranial pressure (ICP) monitoring, and cerebral autoregulation assessment using the long-pressure reactivity index (L-PRx). Despite parasite clearance, cerebral edema developed with radiological signs of intracranial hypertension and ischemic lesions on magnetic resonance imaging. L-PRx demonstrated impaired cerebral autoregulation, whereas ICP remained within noncritical ranges. Continuous electroencephalography excluded epileptiform activity. Gradual neurological improvement allowed extubation after 14 days and hospital discharge after 65 days.Conclusion: This is the first report demonstrating cerebral autoregulatory dysfunction in CM using L-PRx and supports multimodal neuromonitoring to guide individualized hemodynamic strategies to prevent secondary brain injury.