["Top-of-the-basilar" syndrome and Chagas' disease].
BACKGROUND
As a chronic chagasic myocardiopathy, Chagas disease (CD) may give rise to cardiac insufficiency, arrhythmias, thromboembolism and stroke. Occlusive vascular disease of the rostral portion of the basilar artery or of its emergent branches may cause ischemia and necrosis in different areas of the midbrain, thalamic nuclei, cerebellum and occipital lobe.


METHODS
We describe four patients (three males and a female, the average age being 54 years) with positive chagasic serology (indirect immunofluorescence and hemagglutination) and suffering from CD and top of the basilar syndrome. All of them underwent tests to determine proteins C and S, antithrombin III, factor V Leiden, and lupic anticoagulant, as well as being submitted to explorations using electrocardiogram (ECG), echocardiogram, carotid and transcranial echo Doppler, computerised tomography (CAT) and magnetic resonance imaging (MRI).


RESULTS
The coagulopathy studies were normal or negative in the four patients. We also describe the findings from the electrocardiograms (blockage in right branch, two cases; auricular fibrillation, one case; repolarization disorder, one case) and the echocardiograms (left ventricular dysfunction, two patients; apical aneurysm, one patient; mural thrombus, one patient). Neuroimaging revealed one case of each of the following infarctions: bilateral thalamic, bilateral cerebellar and occipital, cerebellar, thalamic mesencephalic and occipital, and thalamic mesencephalic and occipitotemporal.


CONCLUSIONS
In a patient with positive chagasic serology, with or without findings in the ECG and in the electrocardiogram that can be put down to a cardioembolic source, a vascular syndrome produced by occlusion of the distal basilar artery suggest a cardioembolism. We recommend secondary anticoagulation because of the high risk of recurrence.
Carod-Artal
F J
FJ
Servicio de Neurología. Hospital Sarah, Brasilia DF, Brasil. FJCarod@aol.com
Vargas
A P
AP
Melo
M
M
Fernandes da Silva
T V
TV
D000328:Adult; D000368:Aged; D020520:Brain Infarction / Q000175:diagnosis / Q000209:etiology*; D002598:Chagas Cardiomyopathy / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000209:etiology*