Meningite
La meningite che cos’è?
La meningite è un’infiammazione acuta o cronica delle meningi dell’encefalo (meningite cerebrale), del midollo spinale (meningite spinale) o dell’insieme del complesso encefalo-midollare (meningite cerebro-spinale).
Eziologia
Batteri: provocano una reazione infiammatoria della sierosa con essudazione contenente polimorfonucleati alterati (meningite purulenta): meningococco, Haemophilus influenzae , pneumococco, streptococco, stafilococco, salmonella ecc. Il bacillo tubercolare provoca una meningite generalmente non purulenta.
L’infezione può avvenire tramite due vie:
- Via ematogena: i focolai più frequenti sono le infezioni rinofaringee, polmonari ed endocardiche.
- Per contiguità: a partire da una mastoidite, un’otite, da una sinusite, da un ascesso cerebrale o da una tromboflebite nei seni cavernosi.
Virus: meningiti virali.
Spirochete: meningite sifilitica e leptospirosi
Parassiti: tripanosomiasi, trichinosi.
Micosi: criptococcosi, coccidioidomicosi, istoplasmosi, aspergillosi, actinomicosi.
Neoplastiche: disseminazione di cellule neoplastiche nella leucemia o metastasi in particolare nel carcinoma polmonare mammario; tumori primitivi (per esempio liomi)
Sindrome meningea
Sintomi funzionali:
- Cefalea: generalizzata o localizzata, talvolta accompagnata da rachialgia.
- Vomito: spesso a getto, senza rapporto con i pasti.
- Bradicardia relativa: rallentamento del polso in rapporto alla temperatura (polso dissociato).
- Disturbi vasomotori: meno caratteristici.
Sintomi nervosi:
- Contratture: essenzialmente antalgiche e rigidità nucale: la flessione passiva del collo è interrotta da una contrattura e da un vivo dolore.
- Segno di Kernig: il malato non può sedersi sul letto senza flettere la gamba sulla coscia; se si prova ad opporsi a questo movimento mantenendo le gambe in estensione, il paziente si ferma in posizione semiseduta, e prova un dolore.
- Segno di Brudzinski: segno della nuca (la flessione passiva della nuca provoca una pressione delle gambe) e segno controlaterale della coscia (con il paziente steso sul dorso, la flessione passiva della coscia sul bacino di un lato provoca la flessione della coscia opposta)
Iperestesie cutanee, fotofobia ed iperacusia.
Crisi convulsive: generalizzate o localizzate.
Paresi o paralisi, soprattutto oculare.
Disturbi psichici: disturbi del carattere, agitazione, depressione, disturbi della coscienza che possono evolvere nel coma.
Esami di laboratorio
L’esame del liquido cefalorachidiano è importante per confermare la diagnosi di meningite e per precisare l’eziologia. La puntura lombare deve essere prudente, prelievo minimo se vi sono segni di ipertensione intracranica.
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