[Stroke of cardioembolic origin in Chagas disease].
BACKGROUND
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.


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.
Carod Artal
F J
FJ
Servicio de Neurología; Hospital Sarah. Red Sarah de Hospitales del aparato Locomontor, Brasilia DF, 70330-901, Brasil. javier@bsb.sarah.br
Melo
M
M
Vargas
A P
AP
D000818:Animals; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D014355:Chagas Disease / Q000150:complications* / Q000175:diagnosis / Q000469:parasitology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004617:Embolism / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis; D006386:Hemagglutination Tests; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014349:Trypanosoma cruzi / Q000302:isolation & purification