Encefaliti virali
Table of Contents
Definizione
Le encefaliti virali sono il gruppo più frequente di encefaliti. I virus sono organismi intracellulari, quindi il quadro clinico patologico nelle encefaliti consegue alla modalità di interazioni tra virus e cellula. Se il virus realizza unalisi della cellula cerebraleche lo contiene, si ha precoce morte neuronale e/o gliale e focolai dinecrosi;questo produce il quadro sindromico dell’encefalite virale acuta. Se invece il virus persiste nella cellula vitale, i danni funzionali e strutturali si producono lentamente ed i segni e sintomi clinici compaiono in modo subacuto; è questo il meccanismo patogenetico delleencefaliti da virus lenti.
Sintomatologia
Nelleencefaliti virali acutesi ha una triade semeiologica comprensiva di segni di processo infettivo in atto, segni di sofferenza cerebrale generale (disturbi della coscienza e convulsioni), e segni di sofferenza cerebrale a focolaio. Questi ultimi possono variare a seconda del virus in causa. La malattia ha classicamente un decorso bifasico, il quadro clinico inizia con i segni infettivi generali:
- cefalea
- nausea
- vertigini
- disturbi a tipo “influenzale” o a tipo infezione virale indeterminata dellevie respiratorieogastrointestinali.
Dopo pochi giorni di regressione totale di questa sintomatologia, la seconda fase è caratterizzata da segni neurologici(la sindrome da encefalite virale acuta).
La prima fase corrisponderebbe alla prima infezione e viremia, la seconda la localizzazione del virus nel SNC.Lo stato di coscienzaè il primo elemento da considerare tra i sintomi neurologici: se talora l’encefalite decorre senza turbare minimamente la coscienza, spesso invece si possono manifestare disturbi gravi, fino alcoma profondo. E’ da tenere presente che il coma può essere espressione tanto di un interessamento diffuso dell’encefalo quanto di una localizzazione specificamesencefalica o diencefalicadel processo. Disturbi dello stato di coscienza nelle encefaliti sono stati diobnubilamento o di confusione mentalecontorpore psichicooppure stati di eccitamento convaneggiamento e confusione.
Lesioni circoscritte cerebrali possono produrre segni di focolaio quali:
- aprassia
- afasie
- agnosie
- disturbi motori
- crisi epilettiche.
I disturbi della motilità sono estremamente variabili, si possono manifestare:
- emiplegie
- monoplegia
- quadriplegia
- atassia
- movimenti involontarima anche disturbi a carico nei movimenti cranici soprattutto deglioculomotori.
I segni cerebellarisono molto frequenti sotto forma diincoordinazione motoria. Frequenti sono anche isegni extrapiramidaliche consistono essenzialmente in:
- tremori
- ipertonia
- ipercinesie
Frequenti e gravi (fino alla cecità) sono i disturbi dipendenti dalesioni delle vie ottiche. Infine possono essere presenti insieme al quadro encefalico segni di sintomimeningei(dolore, rigidità nucale, Lasègue positivo,Kerning e Brudzinski) emidollari.
Diagnosi
Ladiagnosi clinica di encefaliteviraleè sospettabile sulla base di segni e sintomi neurologici multifocali generali di stato infettivo in un soggetto con frequente disturbo della coscienza. Nella maggior parte dei casi lealterazioni del liquornelle encefaliti sono dimostrative della concomitante meningite:
- aumento della pressione
- aumento delle proteine totali, e degli elementi, soprattutto mononucleati
- glicorrachia normale.
E’ molto difficile isolare il virus dal liquor, mentre è possibile dimostrare lamodificazione dei titoli anticorpali sierici e liquoraliin fase acuta e di convalescenza. Con tecniche di amplificazione mediante PCR è possibile individuare la presenza nel liquor di acidi nucleici appartenenti al virus sospettato sulla base di dati epidemiologici e del quadro clinico.
Le indagini neuroradiologiche (TC E RM) a differenza delle meningiti dimostrano quasi semprelesioni intraparenchimali cerebrali e/o midollaricaratterizzati da alterazioni di segnale a localizzazione diversa a seconda dei casi di virus implicato.
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