Ischemic cerebral changes in the chronic chagasic cardiopathy

Pitella, José Eymard Homem

doi:10.1590/s0004-282x1984000200002

Cited by 41 publications

(25 citation statements)

References 9 publications

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“…Multiple studies [5, 6] have described a correlation between IS and Chagas disease. However, the epidemiology, etiology, prognosis, and factors associated with mortality and recurrence of IS in these cases remain poorly understood [2, 11, 23].…”

Section: Discussionmentioning

confidence: 99%

“…However, the epidemiology, etiology, prognosis, and factors associated with mortality and recurrence of IS in these cases remain poorly understood [2, 11, 23]. Although few studies have evaluated factors associated with cardioembolic etiology [2, 6, 9, 23], to our knowledge, ours is the first study to analyze factors associated with stroke recurrence and mortality outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…A close relationship between Chagas disease and ischemic stroke (IS) has been widely described in literature based on autopsy reports [6], as well as case-control and cohort studies [7, 8] – all these showing increased prevalence of IS, especially during the chronic stage of the disease. However, few studies have focused on identifying factors associated with stroke recurrence or mortality in these patients [9-11].…”

Section: Introductionmentioning

confidence: 99%

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Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

et al. 2018

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Background: Chagas disease is related to ischemic stroke (IS), although few epidemiological studies have evaluated the associated mortality and recurrence. Our objective is to determine factors associated with mortality and recurrence of IS in patients with IS and Chagas disease. Methods: We retrospectively studied data obtained from electronic medical records of patients admitted at SARAH Hospitals across Brazil between 2009 and 2013. Using Cox regression analysis for mortality and logistic regression for recurrence, we assessed primary population characteristics and statistical associations between risk factors and outcomes. Results: We analyzed 279 patients who were followed up until 2016. The mean age at stroke onset was 61 with a 10% frequency of death. Multivariate analysis assessing mortality demonstrated that the associated factors were age at stroke (hazard ratio [HR] 1.04), initial modified Rankin Scale (mRS; HR 20.91), bladder dysfunction (HR 2.51), diabetes mellitus (DM; HR 3.64), and alcoholism (HR 3.37). Multivariate analysis assessing recurrence demonstrated that the associated factors were age at ictus (OR 0.96), cognitive deficit (OR 0.44), initial mRS (OR 1.84), cardioembolic etiology (OR 2.47), and female sex (OR 2.73). Conclusions: Cardiac conditions did not correlate with mortality or recurrence. Age was a protective factor against recurrence, probably due to cumulative risk of IS over time, while initial mRS was associated with both outcomes. Treating diseases such as DM and bladder dysfunction, and early treatment to reduce the initial mRS could potentially prevent both outcomes; also, establishing a correct etiological diagnosis is important.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

et al. 2018

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“…A cerebral form of CD was initially suggested [3], but later refuted by other authors, attributing most brain involvement to cardioembolic stroke [6,9,10]. However, cases of active brain inflammation have been described in immune suppressed patients [10], and brain atrophy has been found pathologically [6].…”

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confidence: 99%

Chagas disease is independently associated with brain atrophy

et al. 2009

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Chagas disease (CD) remains a major cause of cardiomyopathy and stroke in developing countries. Brain involvement in CD has been attributed to left ventricular dysfunction, resulting in chronic brain ischemia due to hypoperfusion and/or embolic infarcts. However, cognitive impairment in CD may occur independently of cardiac disease. Therefore, we aimed to investigate head computed tomography (CT) findings in patients with Chagas disease cardiomyopathy (CDC) in comparison with other cardiomyopathies (OC). We studied 73 patients with CDC (n = 41) or OC (n = 32) matched for age and gender. These patients underwent head CT, rated by an investigator blinded to all clinical information. Head CT was rated for the presence of lacunar or territorial infarcts, as well as for measuring the total volumes of the brain, cerebellum and ventricles. Total brain volume was smaller in CDC as compared to OC patients (1,135 +/- 150 vs. 1,332 +/- 198 cm(3), P < 0.001). Cerebellar and ventricular volumes did not differ between the groups. The prevalence of brain infarcts did not differ significantly between the groups. Chagas disease was the only independent predictor of brain atrophy in the multivariable analysis (OR = 1.38; 95% CI = 1.06-1.79, P = 0.017). Chagas disease is associated with brain atrophy independent of structural cardiac disease related to cardiomyopathy. Brain atrophy, rather than multiple infarcts, may represent the main anatomical substrate of cognitive impairment in Chagas disease.

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“…Por outro lado, lesões maciças, resultantes de acidentes cerebrovasculares, AVC embólicos geralmente secundários a cardiopatia chagásica crô-nica (CCC) podem expressar-se por quadros neurológicos mais evidentes 17. Todavia, nestes casos, a lesão encefálica resulta habitualmente do déficit regional de irrigação provocado pelo AVC, não sendo incomum que, ao longo da evolução da CCC, possam ocorrer vários episódios cerebrais embólicos como sugerido pelos dados de Pittella 13 -Além disso, o comprometimento das condições imunitárias de organismo já albergando T. cruzi em fase crônica da doença de Chagas pode ser acompanhado de exacerbação da fase aguda da doença, como vem sendo demonstrado no homem a partir de observação feita por Mattosinho-França et al 12 . Da mesma forma, em afecções que se acompanham de comprometimento imunitário e nas quais torna-se necessária hemoterapia, esta pode levar a infestação por T. cruzi e desenvolvimento de forma aguda grave da doença como primeiro apontado por Becker 1 .…”

Section: A Trypanosoma Cruzi No Lcr 377 Comentáriosunclassified

Anticorpos a Trypanosoma cruzi no líquido cefalorraqueano: pesquisa pelas reações de fixação do complemento e de imunofluorescência

Spina-França

Livramento

Machado

et al. 1988

Arq. Neuro-Psiquiatr.

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RESUMO -Nas amostras de líqüido cefalorraqueano (LCR) de 200 pacientes com afecções do sistema nervoso central (SNC) foi efetuada pesquisa de anticorpos a Trypanosama cruzi (T. cruzi) mediante: reação de fixação do complemento (RFC) em 69, reação de imunofluorescência (IgG) indireta (RIF) em 118, ambas em 13. Em 50 casos, para a RIF, o LCR foi também previamente concentrado 20 vezes. Os resultados foram avaliados em relação às patologias que acometiam o SNC, ao comportamento das células e proteínas do LCR e ao resultado de investigações imunológicas no LCR para outras infecções do SNC (sífilis, cisticercose, esquistossomíase e toxoplasmose) para as quais técnicas semelhantes foram adotadas. Anticorpos a T. cruzi foram demonstrados em três pacientes: em um com reagudização da moléstia de Chagas na vigência da síndrome de imunodeficiência adquirida; em um paciente com epilepsia e em um paciente com acidente vascular cerebral, ambos com moléstia de Chagas comprovada pela presença de anticorpos a T. cruzi no soro. These tests were based on techniques similar to those adopted for the search of antibodies to T. cruzi, and were conducted concomitantly to tests for T. cruzi in the same CSF sample for everyone of the cases. Antibodies to T. cruzi were found in three patients. Antibodies toThe first was a patient committed by the acquired immunodeficiency syndrome (AIDS) in whom there occurred exacerbation of the acute stage of Chagas' disease.The second is a patient who is committed by epilepsy, and an acute stroke occurred in the third patient; Chagas' disease had been previously diagnosed in them through the demonstration of antibodies to T. cruzi in the blood serum.Limitam-se as possibilidades diagnosticas de acometimento do sistema nervoso central (SNC) na forma crônica da doença de Chagas, à associação: manifestações clínicas compatíveis ao tipo de lesão encefálica comumente provocado pelo Trypanosoma cruzi (T. cruzi); presença de anticorpos ao parasita no soro do paciente. A vigência desse binômio aventa, assim, a possibilidade de diagnóstico provável.

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Ischemic cerebral changes in the chronic chagasic cardiopathy

Cited by 41 publications

References 9 publications

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

Chagas disease is independently associated with brain atrophy

Anticorpos a Trypanosoma cruzi no líquido cefalorraqueano: pesquisa pelas reações de fixação do complemento e de imunofluorescência

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