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Encefalite erpetica: sintomi, prognosi, cura




Esistono due tipi di virus herpes simplex, la forma che dà origine alle tipiche vescicole sulle labbra. Il tipo 1, di norma responsabile di queste lesioni, ed il tipo 2, che di solito è associato a manifestazioni genitali, tuttavia in alcuni casi può provocare anche lesioni alle labbra
L’aciclovir per via endovenosa costituisce il farmaco di scela per l’encefalite erpetica

Definizione

L’encefalite erpetica, causata da herpes Simplex tipo 1 (HVS-1), è la più frequente encefalite virale acuta sporadica con un incidenza di 2-4 casi /milione di abitanti all’anno. Colpisce tutte le età con dei picchi di incidenza tra i bambini e gli anziani.

 

Quali sono i sintomi dell’encefalite erpetica?

Il quadro clinico è generalmente caratterizzato da:

  • Febbre elevata
  • Sintomi neurologici
  • Cefalea

La maggior parte dei pazienti sviluppa precocemente sintomi o segni compatibili con un coinvolgimento mono o bilaterale dei lobi temporali, per esempio:

  • Alterazioni della personalità
  • Deficit di memoria
  • Allucinazioni

Un terzo dei pazienti può presentare crisi epilettiche focali o sintomi e segni neurologici focali come:

  • Emiparesi generalmente più grave al volto e all’arto superiore
  • Afasia
  • Deficit del campo visivo
  • Parestesie

In una minoranza dei casi il quadro può essere diffuso, senza segni di localizzazione.




Prognosi

La prognosi dell’ encefalite erpetica è molto grave, con una mortalità, nei casi non trattati, di circa il 70% e persistenza di postumi neurologici in circa il 90% dei casi. Le conseguenze possono essere anche molto gravi: si parla di disturbi della memoria, emiparesi con perdita parziale della funzione motoria di una parte del corpo, crisi epilettiche.

 

Come si fa diagnosi di encefalite erpetica?

L’encefalite erpetica va presa in considerazione in ogni paziente con sospetta encefalite. La TC e più precocemente, la RM cerebrale, possono fornire elementi molto utili per una diagnosi presuntiva, mostrando lesioni tipicamente in sede temporale mono- o bilateralmente, che spesso coinvolgono anche gli adiacenti lobi frontali e parietali.




Come si cura l’encefalite erpetica?

L’aciclovir per via endovenosa costituisce il farmaco di scelta per la terapia dell’ encefalite erpetica. E’ altrettanto fondamentale l’inizio tempestiva della terapia, poichè un ritardo di ≥ 48 ore è associata una prognosi peggiore. Nella pratica clinica vengono frequentemente utilizzati corticosteroidi, ma la loro reale efficacia non è ancora stata provata. Rimane  da dimostrare l’utilità della somministrazione di valaciclovir al termine della terapia standard nella prevenzione delle recidive.

 

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