Successful management of cerebral malaria requires rapid diagnosis, initiation of appropriate antimalarial agents, and aggressive supportive care. The antimalarial used will depend on drug availability, with many of the most effective agents not routinely available in the US. The use of technologically advanced diagnostic studies, such as electroencephalogram, that are generally not available in malaria-endemic regions may aid in management. But other tests, such as advanced neuroimaging, may offer limited guidance because there are little data indicating the best management of conditions, such as increased intracranial pressure, focal edema, and microhemorrhages. Close clinical assessments and rapid initiation of proven therapies should be the focus of care, even when advanced resources are available. Given the mortality of this condition and the long-term neurologic morbidity seen in survivors, adjunctive therapies are clearly needed to improve patient outcomes. Until more data are available, much of the management of cerebral malaria will continue to be based on anecdote rather than evidence.