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[Stroke of cardioembolic origin in Chagas disease]
F J Carod Artal1, M Melo, A P Vargas
1Servicio de Neurología; Hospital Sarah. Red Sarah de Hospitales del aparato Locomontor, Brasilia DF, 70330-901, Brasil. javier@bsb.sarah.br
Insights
Chagas disease can cause cardioembolic strokes in patients with the chronic cardiac form. Early diagnosis and management are crucial for preventing severe neurological events like stroke.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- American trypanosomiasis, or Chagas disease, is caused by Trypanosoma cruzi.
- The chronic cardiac form affects 10-30% of infected individuals, leading to heart failure, arrhythmias, and thromboembolic events.
- Chagas myocardiopathy is a significant risk factor for stroke.
Observation:
- Two patients with chronic Chagas disease presented with cardioembolic strokes.
- Diagnostic workup ruled out atherothrombotic causes for stroke.
- Both patients exhibited cardiac abnormalities consistent with Chagas myocardiopathy.
Findings:
- One patient experienced multiple cerebral infarcts, including the vertebrobasilar territory, with evidence of dilated cardiomyopathy and atrioventricular block.
- The other patient suffered a middle cerebral artery infarct, presenting with atrial fibrillation and left ventricular dysfunction.
- Both cases confirmed Chagas disease serology.
Implications:
- Chronic cardiac Chagas disease should be considered in the differential diagnosis of cardioembolic stroke.
- This is relevant in both endemic regions and non-endemic countries due to migration.
- Prompt recognition can guide appropriate anticoagulation and management strategies.
Introduction:
American trypanosomiasis, Chagas disease is caused by Trypanosoma cruzi. Between 10% and 30% of infected persons develop the chronic form, with predominance of the cardiac and gastrointestinal forms. Chagas myocardiopathy leads to congestive heart failure, dysrhythmias and thromboembolic phenomena, and may cause strokes.
Patients And Methods:
We report two patients, a 57 year old woman and a 52 year old man, carriers of the chronic cardiac form of Chagas disease, with cardioembolic strokes. In both persons, serology was positive for Chagas disease (indirect hemagglutination and indirect immunofluorescence). The causes of atherothrombotic stroke were ruled out on carotid and transcranial Doppler studies.
Results:
The woman had previously had an infarct of the left middle cerebral artery. She was admitted with a stroke involving the vertebrobasilar territory. On Holter studies there was second degree atrioventricular block and the electrocardiogram showed severe dilated myocardiopathy. On magnetic resonance studies there was an old left temporoparietal infarct and recent ischaemia of the pons and cerebral peduncle. She was anticoagulated and a pacemaker implanted. The man had a right middle cerebral artery infarct. His electrocardiogram showed atrial fibrillation and left anterosuperior block. The echocardiogram showed left ventricular dysfunction and concentric ventricular hypertrophy.
Conclusions:
The chronic cardiac form of Chagas disease should be included in the differential diagnosis of stroke of cardioembolic origin both in endemic areas and in countries to which persons exposed to infection during the early years of life emigrate.