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Ischemic stroke classification and risk of embolism in patients with Chagas disease

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Abstract

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.

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Acknowledgments

The authors would like to thank the SARAH network of rehabilitation hospitals for providing the means and time for the realization of this research paper. No financial benefits were acquired by any of the authors.

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Authors and Affiliations

  1. SARAH Network of Rehabilitation Hospitals, SHMS 501 bloco A Asa sul, Brasília, 70335-901, Brazil

    Vinícius Viana Abreu Montanaro, Creuza Maria da Silva, Carla Verônica de Viana Santos, Maria Inacia Ruas Lima & Edson Marcio Negrão

  2. Universidade Federal Fluminense, Rio de Janeiro, Brazil

    Gabriel R. de Freitas

  3. D’Or Institute for Research and Education, Rio de Janeiro, Brazil

    Gabriel R. de Freitas

Authors
  1. Vinícius Viana Abreu Montanaro
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  2. Creuza Maria da Silva
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  3. Carla Verônica de Viana Santos
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  4. Maria Inacia Ruas Lima
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  5. Edson Marcio Negrão
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  6. Gabriel R. de Freitas
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Correspondence to Vinícius Viana Abreu Montanaro.

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The study protocol was approved by the ethics committee of SARAH hospital.

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The authors declare that they have no conflict of interest.

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Montanaro, V.V.A., da Silva, C.M., de Viana Santos, C.V. et al. Ischemic stroke classification and risk of embolism in patients with Chagas disease. J Neurol 263, 2411–2415 (2016). https://doi.org/10.1007/s00415-016-8275-0

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  • DOI: https://doi.org/10.1007/s00415-016-8275-0

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