Patients with mechanical valvular prostheses are at high risk of embolism and excessive risk of bleeding by Warfarin, the vast majority of whom are cerebral. A sudden neurological deficit in a patient with a prosthetic valve requires brain imaging to determine whether it is an ischemic or haemorrhagic stroke. The decision to restart anticoagulation should be multidisciplinary to counterbalance the risk of cerebral hemorrhage and thrombosis of the prosthetic valve.

The objective is to study the clinical and radiological evolution of patients with mechanical heart valve prostheses complicated by a cerebrovascular accident.

A retrospective study spread over one year (November 2017 to November 2018) on 21cases in the Cardiology Department of Ibn Rochd Casablanca Teaching Hospital.

We report 21observations of patients with cardiac mechanical prostheses placed under warfarin, hospitalized for stroke. Including 14men and 7women with an average age of 35years. Of which 11 patients had mitral prostheses, 3 had aortic prostheses and 7mitro-aortic prostheses. Of these patients, 15 had ischemic stroke and 6hemorrhagic stroke (4 cases with ventricular flood). Radiological monitoring by brain CT from J0 and unfractionated heparin by self-injecting syringe was the method of choice for resuming anticoagulation in 17 patients in agreement with neurologists. The evolution was favorable in 13 patients (61, 9%) with a good relay to warfarin (10AVCI and 3AVCH), a haemorrhagic transformation in 5patients with. We had death of 3patients who had hemorrhagic stroke.

The prognosis can be put into play after the occurrence of stroke in patients with mechanical heart valves, a risk of cerebral hemorrhage in case of early resumption of anticoagulants and thrombotic risk of prostheses in case of a delayed recovery.