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.