Successful thrombolysis in cardioembolic stroke from Chagas disease

Chagas disease, caused by Trypanosoma cruzi , is a major cause of cardiomyopathy and stroke in South America and affects 16 to 18 million people.1 The main manifestations of cardiac disease are cardiomyopathy, congestive heart failure, arrhythmias, and thromboembolic phenomena, which can appear up to 30 years after the acute infection. Since 1995, thrombolytic therapy has been used increasingly in acute ischemic stroke.2 However, patients with high risk of cardiac thrombus (e.g., after acute myocardial infarction) were excluded from the major multicenter studies. Additionally, rare cases of focal deficits caused by vasculitis have been described related to Chagas disease,3 which may not respond to thrombolysis. Therefore, the risk of thrombolytic therapy in Chagas disease should be better studied. We describe the first two cases of thrombolytic therapy in acute stroke caused by Chagas disease. ### Case 1. A 73-year-old man was admitted with sudden onset of right hemiplegia and aphasia 30 minutes before admission. …