Multiple Strokes in a Latin American Patient.

MedStar author(s):
Citation: Case Reports in Neurology. 13(2):441-445, 2021 May-Aug.PMID: 34326753Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Internal Medicine ResidencyForm of publication: Journal ArticleMedline article type(s): Case ReportsSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2021ISSN:
  • 1662-680X
Name of journal: Case reports in neurologyAbstract: We present a case of a recent immigrant from El Salvador without past medical history who presented to our hospital with symptoms concerning for acute stroke. Brain magnetic resonance imaging (MRI) with gadolinium confirmed an acute stroke along with multiple prior infarcts involving different vascular beds. Head magnetic resonance arteriogram did not reveal any occlusions/stenosis or aneurysmal changes. His subsequent extensive evaluation included an electrocardiogram (ECG) that revealed bifascicular block and echocardiography that suggested an apical aneurysm, but images were limited to assess. To further assess the likelihood of cardiac embolism, he underwent cardiac MRI with gadolinium, which confirmed the apical aneurysm. Because of his country of origin and classic ECG and echo findings, Chagas disease was suspected, and both commercial ELISA and confirmatory ELISA and TESA blots were positive. This is both a classic presentation of Chagas cardiomyopathy and an important reminder that Chagas disease should be considered in the differential diagnosis of cardioembolic stroke in Latin American immigrants from an endemic country. Copyright (c) 2021 by S. Karger AG, Basel.All authors: Halaseh R, Marcus R, Shehadeh MFiscal year: FY2021Digital Object Identifier: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34326753 Available 34326753

We present a case of a recent immigrant from El Salvador without past medical history who presented to our hospital with symptoms concerning for acute stroke. Brain magnetic resonance imaging (MRI) with gadolinium confirmed an acute stroke along with multiple prior infarcts involving different vascular beds. Head magnetic resonance arteriogram did not reveal any occlusions/stenosis or aneurysmal changes. His subsequent extensive evaluation included an electrocardiogram (ECG) that revealed bifascicular block and echocardiography that suggested an apical aneurysm, but images were limited to assess. To further assess the likelihood of cardiac embolism, he underwent cardiac MRI with gadolinium, which confirmed the apical aneurysm. Because of his country of origin and classic ECG and echo findings, Chagas disease was suspected, and both commercial ELISA and confirmatory ELISA and TESA blots were positive. This is both a classic presentation of Chagas cardiomyopathy and an important reminder that Chagas disease should be considered in the differential diagnosis of cardioembolic stroke in Latin American immigrants from an endemic country. Copyright (c) 2021 by S. Karger AG, Basel.

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