The neuropsychiatric manifestations of postmalaria neurological syndrome (PMNS) that have been described are highly variable and include an acute confusional state or acute psychosis with >or=1 of the following symptoms: clouding of consciousness, inappropriate speech or behavior, visual hallucination, catatonia with waxy flexibility, generalized convulsion, fine postural tremor, and decreased muscle tone. This postinfectious syndrome occurs after the clearance of parasitemia and is not a manifestation of cerebral malaria. We present the first identified case of and magnetic resonance imaging findings for a patient with PMNS in the United States.