Neurologic manifestations of Chagas disease

Chagas disease is endemic in Latin America and has become an emerging problem in developed countries because of international migrations. The protozoan Trypanosoma cruzi is the etiologic agent and the disease is divided into two phases. The acute phase is mostly asymptomatic or presents with unspecific symptoms. Rarely, a severe and often fatal form occurs in immunosuppressed patients or infants, characterized by meningoencephalitis (sometimes including brain tumor-like lesions) and myocarditis. The chronic phase consists of an indeterminate, asymptomatic form followed by digestive, cardiac, or neurologic symptoms in about 30% of infected patients. Autonomous nervous system dysfunction is prominent in chagasic patients and participates in the affliction of the target organs. Stroke, mainly cardioembolic, may occur in the chronic phase, but other stroke etiologies are reported. Embolic sources and inflammation are thought to play a role in stroke mechanisms. Specific treatment for Chagas disease is scarce and preventive measures are needed.