These symptoms of cerebral malaria are caused by microvascular obstruction that prevents the exchange of glucose and oxygen at the capillary level, hypoglycemia, lactic acidosis, and high-grade fever. These events impair brain function, yet rapid and full recovery most often follows prompt treatment.
Renal failure, due to acute tubular necrosis, is a common complication of severe P. falciparum infections in nonimmune persons. The renal tubules can become clogged with hemoglobin and malarial pigment released during massive hemolysis, and microvascular obstruction can cause anoxia and glucose deprivation. An enlarged, tender spleen and a palpable liver was often present by the second week of infection.