Stroke in asymptomatic Trypanosoma cruzi-infected patients.
BACKGROUND
The knowledge about the natural history of stroke in Chagas disease is incomplete.


METHODS
Vascular risk factors and stroke subtypes of asymptomatic Trypanosoma cruzi-infected patients with no clinical evidence of heart failure were assessed. They were compared with chronic chagasic cardiomyopathy patients who suffered a stroke and with a control group of 60 T. cruzi-noninfected stroke patients. Eighty-six consecutive chagasic stroke patients (mean age: 57.4 years; 64% females) were studied.


RESULTS
38.4% of chagasic stroke patients had asymptomatic T. cruzi infection. Smoking was more frequent in asymptomatic chagasic stroke patients (21.2 vs. 5.7%; p = 0.04). Prevalence of hypertension, diabetes and prior stroke was similar in both groups. Small-vessel infarction (15.6 vs. 3.8%) and large-vessel atherosclerosis (9.4 vs. 3.8%) were significantly more frequent in asymptomatic than in symptomatic T. cruzi-infected stroke patients (p = 0.001). Nevertheless, their frequency was even higher in T. cruzi-noninfected stroke patients (36.7 and 13.3%, respectively). Apical aneurysm (27.3%), left atrial dilatation (12.1%), left ventricle hypokinesia (9.4%) and right bundle branch block (36.4%) were also detected in asymptomatic T. cruzi-infected stroke patients.


CONCLUSIONS
Ischemic stroke may be the first manifestation of Chagas disease in asymptomatic patients with mild left ventricle dysfunction. Other noncardioembolic stroke subtypes can occur in asymptomatic T. cruzi-infected patients.
Carod-Artal
Francisco Javier
FJ
Department of Neurology, Virgen de la Luz Hospital, Avenida Hermandad Donantes de Sangre s/n, Cuenca, Spain. fjcarod-artal@hotmail.com
Vargas
Antonio Pedro
AP
Falcao
Thiago
T
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000453:epidemiology / Q000469:parasitology* / Q000503:physiopathology; D001938:Brazil; D002598:Chagas Cardiomyopathy / Q000453:epidemiology / Q000469:parasitology* / Q000503:physiopathology; D014355:Chagas Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000469:parasitology* / Q000503:physiopathology; D014349:Trypanosoma cruzi / Q000472:pathogenicity*; D018487:Ventricular Dysfunction, Left / Q000469:parasitology; D016277:Ventricular Function, Left