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Stroke: a neglected complication of American trypanosomiasis (Chagas' disease)

Francisco Javier Carod-Artal1

  • 1Department of Neurology, The Sarah Network of Rehabilitation Hospitals, Sarah Hospital, SMHS quadra 501 conjunto A, CEP 7330-150, Brasilia DF, Brazil. javier@sarah.br

Transactions of the Royal Society of Tropical Medicine and Hygiene
|July 31, 2007
PubMed

Insights

Chagas' disease (CD) significantly increases stroke risk, often due to cardiac complications like cardiomyopathy. Early detection and prevention programs are crucial for managing this neglected public health issue.

Area of Science:

  • Cardiology
  • Neurology
  • Infectious Diseases

Background:

  • American trypanosomiasis, or Chagas' disease (CD), is a significant public health concern in South America.
  • It is a frequent cause of chronic cardiomyopathy and stroke, often appearing decades after initial infection.
  • The role of CD as an independent stroke risk factor is often underestimated.

Purpose of the Study:

  • To review the role of Chagas' disease as an independent risk factor for stroke.
  • To highlight the link between chagasic cardiomyopathy and cardioembolic stroke.
  • To emphasize the need for increased awareness and prevention strategies.

Main Methods:

  • Review of existing literature on Chagas' disease and stroke.
  • Analysis of potential embolic factors in chagasic stroke patients.
  • Estimation of prevalence of apical aneurysm and mural thrombus in CD stroke patients.

Main Results:

  • Chronic cardiomyopathy affects approximately 30% of CD patients, leading to potential embolic factors like arrhythmias, heart failure, apical aneurysm (37% in CD stroke patients), and mural thrombus (11.7% in CD stroke patients).
  • Stroke can be the initial manifestation of CD, even with mild or undetected cardiac dysfunction.
  • CD diagnosis occurs post-stroke in about 40% of cases, with less than 5% awareness of stroke risk among chagasic patients.

Conclusions:

  • Chagasic cardiomyopathy is a frequently unrecognized source of cardioembolic stroke.
  • Increased awareness and educational/prevention programs are essential to mitigate stroke risk in chronic CD patients.
  • Addressing this neglected complication is vital for public health in South America.

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