Ischemic stroke classification and risk of embolism in patients with Chagas disease.
Ischemic stroke (IS) and Chagas disease are strongly related. Nevertheless, little attention has been paid to this association and its natural history. The current guidelines concerning the management and secondary prevention of IS are largely based on the incomplete information or extrapolation of knowledge from other stroke etiologies. We performed a retrospective study which compared stroke etiologies among a cohort of hospitalized patients with IS and Chagas disease. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC/FIOCRUZ) embolic score was also used to identify and evaluate the risk of embolism in this population. A total of 86 patients were included in the analysis. The mean age of the study population was 58 years, and 60 % were men. According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification, 45 % of the strokes were of undetermined etiology and 45 % of cardioembolic origin, while the Stop Stroke Study/Causative Classification System (SSS/CCS) TOAST indicated that 34 % were undetermined and 50 % cardioembolic (p < 0.01); 44 % of these patients were classified as having a high embolic risk according to the IPEC/FIOCRUZ score. Among the undetermined causes, 83.3 % fulfilled the criteria for embolic stroke of undetermined source (ESUS). The SSS/CCS TOAST etiological classification system was superior to the classical TOAST criteria in identifying a cardioembolic etiology in patients with ischemic stroke and Chagas disease. The IPEC/FIOCRUZ score did not correlate with the number of patients who were determined to have cardioembolic stroke etiologies. The current guidelines for stroke prevention should be reviewed in this population.
SARAH Network of Rehabilitation Hospitals, SHMS 501 bloco A Asa sul, Brasília, 70335-901, Brazil. vinicius_montanaro@yahoo.com.br.
Vinícius Viana Abreu
VV
Montanaro
SARAH Network of Rehabilitation Hospitals, SHMS 501 bloco A Asa sul, Brasília, 70335-901, Brazil.
Creuza Maria
CM
da Silva
SARAH Network of Rehabilitation Hospitals, SHMS 501 bloco A Asa sul, Brasília, 70335-901, Brazil.
Carla Verônica
CV
de Viana Santos
SARAH Network of Rehabilitation Hospitals, SHMS 501 bloco A Asa sul, Brasília, 70335-901, Brazil.
Maria Inacia Ruas
MI
Lima
SARAH Network of Rehabilitation Hospitals, SHMS 501 bloco A Asa sul, Brasília, 70335-901, Brazil.
Edson Marcio
EM
Negrão
Universidade Federal Fluminense, Rio de Janeiro, Brazil.|D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
Gabriel R
GR
de Freitas
D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging; D014355:Chagas Disease / Q000150:complications* / Q000000981:diagnostic imaging; D004569:Electroencephalography; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004617:Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000145:classification* / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology
Chagas; Embolism; Ischemic; Stroke