Neurological manifestations of Chagas' disease.

OBJECTIVES: To review the neurological manifestations of Chagas' disease, including its clinical presentation, diagnosis, management, treatment and follow-up.
METHODS: A systematic review of the literature found in MEDLINE, EMBASE, LILACS and SCIELO was performed to search for relevant references on Chagas' disease and neurological manifestations.
RESULTS: The involvement of the nervous system in Chagas' disease is well established. The acute phase is described as a meningoencephalitis that more frequently affects children under 2 years old and is almost always fatal in those with coexistent myocarditis and cardiac insufficiency. In the chronic phase, it presents as neuritis that results in altered tendon reflexes and sensory impairment, and is reported in up to 10% of the patients. Isolated cases of central nervous system involvement can also include dementia, confusion, chronic encephalopathy and sensitive and motor deficits. Concurrent immunosuppression, such as that related to human immunodeficiency virus and organ transplantation, can result in the reactivation of the Trypanosoma cruzi infection. In these patients meningoencephalitis and brain abscesses may occur with a high mortality rate despite specific treatment. DISCUSSION: Although neurological involvement is infrequent, it has a high mortality and morbidity rate when is not well diagnosed and treated on time.