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Cerebral infarct topography of atrial fibrillation and Chagas disease
Vinícius Viana Abreu Montanaro1, Thiago Falcão Hora1, Creuza Maria da Silva2
1SARAH Network of Rehabilitation Hospitals, Brasília, Brazil.
Insights
Patients with atrial fibrillation (AF) and ischemic stroke (IS) face worse outcomes than those with Chagas disease (CD) and IS. Stroke location does not help determine the cause, suggesting potential autonomic nervous system involvement in CD.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Chagas disease (CD) and ischemic stroke (IS) share a poorly understood link.
- Limited evidence exists on secondary prevention and causes of IS in CD patients.
Purpose of the Study:
- Compare arterial stroke patterns, morbidity, and mortality in patients with CD (undetermined vs. cardioembolic etiology) and cardioembolic IS due to atrial fibrillation (AF).
Main Methods:
- Retrospective analysis of electronic medical records for IS patients.
- Comparison of vascular topography and outcomes between CD (cardioembolic/undetermined etiology) and AF groups.
- Data collected from SARAH Hospital Brasilia between 2009 and 2013.
Main Results:
- Middle cerebral artery strokes were most common, particularly in CD of undetermined etiology.
- No significant differences in arterial territories affected were observed.
- Atrial fibrillation patients exhibited poorer modified Rankin Scale scores and higher mortality rates compared to CD patients.
Conclusions:
- Stroke topography is insufficient for etiological diagnosis.
- Patients with AF and IS experience worse outcomes than those with CD and IS.
- The autonomic nervous system may be implicated in Chagas disease-related stroke.
Background:
Chagas disease (CD) and ischemic stroke (IS) have a significant but poorly understood correlation. There is paucity of evidence regarding secondary prophylaxis of IS and etiological causes.
Objectives:
To compare arterial stroke topography and the respective morbidities and mortality in patients with CD of undetermined and cardioembolic etiologies and with cardioembolic IS (atrial fibrillation [AF]).
Methods:
We compared vascular topography and outcomes using data obtained from the electronic medical records of all patients with IS with either CD (with cardioembolic or undetermined etiology) or AF, admitted to SARAH Hospital Brasilia between 2009 and 2013.
Results:
A total of 115 patients were investigated: 49 involving AF, 23 involving CD of unclear etiology, and 43 involving CD of cardioembolic etiology. Middle cerebral artery stroke was predominant in all groups, although more frequent in patients with CD of undetermined etiology. No significant difference was found in the arterial territories. Hemodynamic stroke was predominant among CD patients who experienced cardioembolic events. AF patients had worse modified Rankin scale scores upon admission and a higher mortality rate than CD patients in both categories.
Conclusions:
Stroke topography is not useful in determining the etiological diagnosis. Patients with AF and IS are more likely to have worse outcomes than are those with CD and IS. The autonomic nervous system could be affected in patients with CD.
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