Neurological Manifestations in Chagas Disease without Cardiac Dysfunction: Correlation between Dysfunction of the Parasympathetic Nervous System and White Matter Lesions in the Brain

UNLABELLED: Chagas disease (American Trypanosomyasis) is endemic in South America. It has been associated with autonomic dysfunction and increased stroke risk. OBJECTIVE: To correlate findings in neurological examination, autonomic nervous system function, and brain magnetic resonance imaging (MRI), in patients with chronic Chagas disease. METHODS: Neurological findings of 64 patients from a hospital cohort were correlated with disease stage (according to Los Andes classification) and with signs of autonomic nervous system function (respiratory sinus arrhythmia test). Also, 27 subjects with no cardiac dysfunction (phase IA) had MRI evaluation. Results were correlated with autonomic nervous system variables using Spearman correlation coefficient and Mann-Whitney test. RESULTS: There was a significant correlation between the presence and number of white matter hyperintensities in MRI and the respiratory sinus arrhythmia test. There was no correlation between disease stage and autonomic nervous system dysfunction. CONCLUSION: There is a significant correlation between parasympathetic nervous system dysfunction and the presence of white matter lesions in patients with chronic Chagas disease without cardiac dysfunction. The pathogenesis of such lesions is unknown, but cardiac arrhythmias could be involved. As hypertension was frequent in our sample and also correlated to MRI hyperintensities, studies excluding hypertensive patients are needed to confirm our results.