Document Type : Original Article(s)


1 MD, Associate Professor of Neurology, Neurology Division, Valie-Asr Hospital, Ghaffari Street, Birjand, Khorasan.

2 MD, Division of Emergency Medicine, Director.


AbstractINTRODUCTION: Rheumatic valvular disease is a common complication of rheumaticfever in children in developing countries. Later in life, rheumatic valvular diseasebecomes an important modifiable risk factor of stroke. The incidence of rheumaticvalvular disease and its complications are unknown in Iran.METHODS: This is a prospective study of 302 consecutive patients admitted to atertiary care hospital in Iran, with a diagnosis of non-hemorrhagic stroke between June2005 and June 2006. All patients underwent diagnostic workup to determine strokeetiology according to clinical indications. Diagnosis and classification of stroke was madebased on the PIC criteria.RESULTS: In 302 patients with stroke (mean age: 66.78±14.36 years), 60 patients(20%) (mean age: 65.61±17.48 years) had cardiac sources of embolism (CSE). Rheumaticmitral stenosis was present in 28 (46.6%) of these patients. Atrial fibrillation wasdocumented in 19 patients (67.8%) with rheumatic valvular disease. The remaining 32patients (53.3%) had other CSE. In the latter group, 8 patients (25%) had non-valvularatrial fibrillation. In the entire group with CSE, a total of 30 patients were candidates foranticoagulation; among them, 14 (46.6%) were anticoagulated, but only 6 (20%) werewithin therapeutic range at the time of their stroke.CONCLUSIONS: Rheumatic valvular disease seems to be the most common CSE in Iran.Many patients with rheumatic or non-rheumatic CSE are not adequately managed forsecondary prevention of cardioembolic stroke.Key Words: Cardioembolic, stroke, rheumatic.