Chagas disease is a vector-borne disease with multiorgan involvement. The presence of cerebral infarctions has been described in Chagas disease in autopsy cases, clinical case series, and case-control studies. However, only in the 21st century it was formally considered an independent risk factor for stroke. Few studies have focused on identifying the risk of ischemic stroke in patients with chronic infection, with or without cardiac involvement. Recent papers have addressed these points, especially regarding mortality, recurrence, and etiological diagnosis. However, there is still a long way to go in enhancing the correct management and diagnosis of these patients. New technologies such as cardiac magnetic resonance and artificial intelligence may help, but their practical use is still limited. Trials using anti-aggregation versus anticoagulants could be the answer in managing these patients and answering a long-standing question: should we anticoagulate or not patients with Chagas disease and a stroke of undetermined etiology? Keywords: Chagas disease, Ischemic Stroke, Epidemiology, Etiological classification, secondary prevention, Outcomes
