Background and aim: Cerebral malaria in Gambian children has been studied but there is limited information on CM in adults. The study assesses the clinical features and outcome of CM in adult patients admitted at the Edward Francis Small Teaching Hospital. Method: This was a retrospective review of all adult patients with malaria admitted to the internal medicine department from October 18, 2020 to February 2, 2022. Results: A total number of 319 adults were admitted with malaria. Eighty (25%) patients met the criteria for CM. The median age of the CM patients was 19 years. CM patients were younger (<i>p</i> < 0.001), more likely to be of the adolescent age group (<i>p</i> < 0.001), more likely to be referred from a lower-level health facility (<i>p</i> < 0.001), and more likely to be admitted in intensive care <i>p</i> < 0.001) as compared to NSCM or UM patients. The total in-hospital mortality of CM patients was 23.8%. Ten (52.6%) out of the 19 patients died within the first 24 h of admission. In multivariate analysis, CM patients with acute kidney injury at presentation was an independent predictor of mortality in this study. Conclusion: CM seems to affect the adolescent age group more than the older adults in The Gambia. The clinicians should be able to identify these high-risk patient group and institute prompt critical care interventions and/or treatment. The findings in this study also identify the need to expand access of critical care interventions and hemodialysis to help improve the prognosis of adult CM patients in The Gambia.