Seventy-five cases of childhood cerebral malaria (CM) seen within a 30-month period (January 1986 to June 1988) in the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria were prospectively studied. Fifty-five percent of the victims were aged 1-5 years while 39% were between 6 and 10 years. Eight percent of the cases were postmortem surprises, their condition having been masked by other complications of malaria. At variance with the accepted definition of CM, 20% of the patients neither convulsed nor lost consciousness. In searching for any delineating premortem features of the disease, a combination of fever, multiple seizures, coma with severe anaemia did appear impressive and also a co-existence of tonic-clonic with pure tonic seizures was highly suspicious. The need to heighten the index of suspicion and encourage extensive research into this lethal aspect of malaria is stressed.