Neurocisticercosi
Definizione
La neurocisticercosi è causata dallo stadio larvale della tenia di maiale Taenia solium, e viene trasmessa per ingestione di alimenti contaminati con uova di parassita, generalmente presenti nelle feci di un portatore umano. Dopo l’ingestione, gli embrioni (oncosfere), si schiudono nell’intestino tenue, invadono la parete intestinale e si diffondono per via ematogena a cervello, muscolo scheletrico, fegato e/o altri tessuti. Durante un periodo di 3-8 settimane si sviluppano i cisticerchi, che consistono di pareti membranose ripiene di liquido e di uno scolice invaginato. Localizzate nel cervello provocano la neurocisticercosi, le altre la cisticercosi extraneurale.
Incubazione e sintomi
Il periodo di incubazione mediano prima dell’inizio dei sintomi è di 3 anni e mezzo.
Le principali manifestazioni cliniche della neurocisticercosi sono:
- Convulsioni
- Idrocefalo ostruttivo
- Segni e sintomi di ipertensione endocranica (cefalea, nausea, vomito, alterazioni del visus, confusione).
Diagnosi
La diagnosi di cisticercosi deve essere sospettata in pazienti con segni e sintomi suggestivi e reperti neuroradiologici compatibili (lesioni cistiche, lesioni ad impregnazione constrastografica e/o lesioni calcifiche) nel contesto epidemiologico adeguato.
Trattamento
L’approccio iniziale ai pazienti con neurocisticercosi consiste nella gestione dei sintomi, se presenti, come quelli dovuti a ipertensione endocranica e le convulsioni. Successivamente, può essere iniziata la terapia antiparassitaria (albendazolo con o senza praziquantel per 10-14 giorni di solitamente) nei pazienti con cisti cerebrali vitali e/o in fase di degenerazione e deve essere sempre combinata con la terapia corticosteroidea sistemica ad alte dosi per tutta la durata del trattamento. La terapia antiparassitaria non deve essere somministrata a pazienti con idrocefalo non trattato,encefalite o lesioni calcifiche.
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