Stroke as First Presentation of Rheumatic Heart Disease in Pediatric Age Group - a Case Report from Developing Country, Rwanda.

BACKGROUND

Rheumatic heart disease (RHD), a chronic consequence of acute rheumatic fever, rarely presents with stroke as an initial manifestation in children. This report shows a rare scenario where ischemic stroke was the first clinical presentation of underlying RHD.

CASE PRESENTATION: A 10-year-old boy presented with seizures, hemiplegia, and expressive aphasia. Echocardiography revealed rheumatic mitral valve disease with a vegetation. Neuroimaging showed multifocal cerebral infarctions suggestive of cardioembolism.

CONCLUSION

This case emphasizes the importance of echocardiographic screening in pediatric patients presenting with stroke, particularly in endemic regions where subclinical RHD may go undiagnosed.