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. 2022 Jun 6:55:e0575.
doi: 10.1590/0037-8682-0575-2021. eCollection 2022.

Stroke in Chagas disease: from pathophysiology to clinical practice

Thaís Aparecida Reis Lage  1 , Julia Teixeira Tupinambás  1 , Lucas Bretas de Pádua  2 , Matheus de Oliveira Ferreira  2 , Amanda Cambraia Ferreira  3 , Antonio Lucio Teixeira  1   4 , Maria Carmo Pereira Nunes  1   2
Affiliations

Stroke in Chagas disease: from pathophysiology to clinical practice

Thaís Aparecida Reis Lage et al. Rev Soc Bras Med Trop. .

Abstract

Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.

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Conflict of interest statement

Conflict of Interest: The authors declare that there is no conflict of interest.

Figures

FIGURE 1(A and B):
FIGURE 1(A and B):. Ischemic stroke in the territory of the right middle cerebral artery (ischemic area indicated by white arrow) in a 54-year-old patient with Chagas disease. An echocardiogram showed reduced left ventricular ejection fraction with thrombus at apical aneurysm, classifying the stroke as cardioembolic.
FIGURE 2:
FIGURE 2:. Echocardiographic image at the apical four-chamber view of a patient with Chagas disease presented with stroke. A large left ventricular apical aneurysm (white arrow) is seen. The right ventricle has a normal size with a pacemaker wire in the right atrium (arrow). RV: right ventricle, LV: left ventricle, RA: right atrium, LA: left atrium.
FIGURE 3:
FIGURE 3:. Stroke of atherosclerotic etiology in a 67-year-old patient with Chagas disease. The ischemic territory is indicated by a black arrow in the semioval center on the left. Significant intracranial atherosclerosis is detected.
FIGURE 4:
FIGURE 4:. Patient with Chagas disease, 60 years old, with a history of multiple strokes. Areas of malacea were identified in the left frontal lobe, indicated by back arrows.
See this image and copyright information in PMC

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