Beyond cardiac embolism and cryptogenic stroke: unveiling the mechanisms of cerebrovascular events in Chagas disease.

Abstract

Chagas disease, caused by the protozoan parasite <i>Trypanosoma cruzi</i>, remains a significant public health challenge with evolving epidemiological patterns due to migration and globalization. While its cardiac complications are well-characterized, stroke represents an underrecognized yet devastating manifestation, occurring in 3%-20% of patients. Traditionally viewed primarily as a cardioembolic pathophysiology, emerging evidence suggests a more complex pathophysiologic mechanism involving inflammatory, prothrombotic, and microvascular processes. This narrative review examines the multifaceted mechanisms underlying stroke in Chagas disease, integrating recent insights into both cardiac and non-cardiac pathways. We analysed current approaches to risk stratification and prevention, including the utility of the IPEC-FIOCRUZ score and limitations in implementing anticoagulation strategies. This review also addresses emerging challenges, such as the aging of affected populations and limited disease recognition in non-endemic regions, while highlighting opportunities for improving care.