systemic lupus erythematosus ( sle ) is a chronic autoimmune disease of unknown cause which can affect several parts of the body even central nervous system ( cns ) .. among cns manifestations , cerebrovascular accident ( cva ) is one of the severe complications . previous cohort studies revealed that 3 - 20% of sle patients may experience an episode of cva during their course of the disease . data about differential features and various subtypes of cva in iranian sle patients are lacking . in this study , we aimed to determine the prevalence and prognosis of cva and its subtypes among iranian sle patients . this study was a cross - sectional hospital clinic - based study that performed in isfahan , iran . during the period of 1 year , since february 2010 - 2011 , sle patients attending the rheumatology clinic of alzahra hospital ( a tertiary referral center in isfahan , iran ) enrolled in the study . their medical documents have been reviewed and patients who had developed acute cva include of ischemic attack , hemorrhagic attack , cerebral vasculitis and cerebral vein thrombosis in their course of disease were extracted . drug - induced vasculitis , generalized vasculopathy , transverse myelitis and loss of consciousness due to metabolic disorders were causes of exclusion . in patients who enrolled the study demographic data , sle related clinical and laboratory findings and neurological symptoms in the disease duration were recorded . sle was diagnosed according to the revised criteria which suggested by american college of rheumatology at 1997 . diagnosis was based on the clinical features and on data collected by brain imaging . in patients with cva , demographic features , history of hypertension , dyslipidemia and diabetes mellitus , anti - phospholipid antibodies ( apla ) , duration of the disease until cva , cva manifestation(s ) and follow - up duration were extracted . in the next step , patients with any kinds of cva were summoned to neurology clinic to identify the grade of disability . the grade of disability of cva determined for each patient through a precise neurological exam by a single expert neurologist using modified rankin scale ( mrs ) . imaging study of each patient ( which was done at the time of hospitalization ) was studied again and the subtype of cva was confirmed by a single neurologist . we used spss 20.0 software ( ibm spss statistics ) for analysis of the data . this study was a cross - sectional hospital clinic - based study that performed in isfahan , iran . during the period of 1 year , since february 2010 - 2011 , sle patients attending the rheumatology clinic of alzahra hospital ( a tertiary referral center in isfahan , iran ) enrolled in the study . their medical documents have been reviewed and patients who had developed acute cva include of ischemic attack , hemorrhagic attack , cerebral vasculitis and cerebral vein thrombosis in their course of disease were extracted . drug - induced vasculitis , generalized vasculopathy , transverse myelitis and loss of consciousness due to metabolic disorders were causes of exclusion . in patients who enrolled the study demographic data , sle related clinical and laboratory findings and neurological symptoms in the disease duration were recorded . sle was diagnosed according to the revised criteria which suggested by american college of rheumatology at 1997 . diagnosis was based on the clinical features and on data collected by brain imaging . in patients with cva , demographic features , history of hypertension , dyslipidemia and diabetes mellitus , anti - phospholipid antibodies ( apla ) , duration of the disease until cva , cva manifestation(s ) and follow - up duration were extracted . in the next step , patients with any kinds of cva were summoned to neurology clinic to identify the grade of disability . the grade of disability of cva determined for each patient through a precise neurological exam by a single expert neurologist using modified rankin scale ( mrs ) . imaging study of each patient ( which was done at the time of hospitalization ) was studied again and the subtype of cva was confirmed by a single neurologist . we used spss 20.0 software ( ibm spss statistics ) for analysis of the data . of the total number 575 patients ( 64 men and 511 women ) enrolled in the study , 38 were identified to have cva . 6 ( 15.8% ) were men and 32 ( 84.2% ) were women . their ages at the time of cva ranged from 19 to 69 years , with the mean of 35.1  1.2 years . small vessels thrombosis was the most common subtype , which includes eight patients ( 21.05% ) . cva subtypes among iranian sle patients who enrolled in the study 12 ( 31.6% ) patients had a history of hypertension ; positive history of diabetes mellitus was present in two ( 5.7% ) patients and seven ( 18.4% ) had hyperlipidemia . duration of sle before cva in the study patients ranged from 0 to 16 years , with the mean of 4.25  4.59 years . in 11 ( 28.9% ) patients sle was initiated with cva and in three ( 7.9% ) patients cva was happened in the 1 year of sle . in fact , in 88.2% of all ischemic attacks ( include of large vessels thrombosis , small vessels thrombosis and cardio emboli ) aplas were positive . with the mean follow - up of 4.4  3.4 years , the cva had recurred and in two patients transient ischemic attacks was recorded prior to cva . the comparison of mrs and sle duration before cva among cva patients with positive and negative apla the most common cva manifestation in our study was hemi paresis , which occurred in 15 ( 39.47% ) patients . previously , it has been demonstrated that age of sle onset and sex ratio in iranian patients are similar to those from other racial groups . this prevalence is also within the range that reported from other parts of the world . of the 38 cva patients , in 11 cases futrell et al . implied that most sle patients who develop cva have their first cva during the first 5 years of their disease and the highest rate is found during the 1 year . in fact , it seems that in some patients sle has special tendency to involve cerebral vessels , which is not related to the duration of sle , but the nature of sle . the current study implies that a large proportion of all acute cvas in iranian sle patients are constituted by ischemic attacks . this fact may reflect the influence of apla and other autoantibodies , premature atherosclerosis , small vessel vasculopathy , arterial and venous thrombosis , embolism and vessel spasm in sle . although cvt , posterior reversible encephalopathy syndrome ( pres ) and cva secondary to hypercoagulable state are not in toast classification , but in that classification there is a category for  stroke of other determined etiology . we expanded the classification for more exact recognition of stroke subtypes in sle patients . among our patients , we identified three cases of cvt . our data showed that cvt is constituted 7.9% of cvas in iranian sle patients , which is higher than the prevalence of cvt in the normal population . there is no study about the rate of pres in sle patients . although pres is not one of the classic cva subtypes , but as the mechanism of pres is cerebral vasospasm and because of endothelium dysfunction in sle patients , we report pres as the cause of 7.9% of cvas in iranian sle patients . as following the average follow - up of 4.4 years , mean mrs of patients were less than 1 , we may construe that if a patient with sle survives cva and his or her 5 year rehabilitation would not be unfavorable . significant relationship between apla and mrs ( p = 0.006 ) shows that in patients with negative serology for apla , morbidity rate of cva is even less . our study also has some limitations ; this study was not hospital - based so we were unwitting about the mortality rate of cva in sle patients . thus , the prevalence of cva in iranian sle patients that we have identified is likely to be an underestimation of the true frequency . second , due to positive history of some factors such as hypertension , hyperlipidemia and diabetes mellitus in some stroke patients , it was favorable to operate proper statistical tests for eliminating their effects on the occurrence of stroke . however , as our recorded data about the presence of these factors in other non - stroke patients was not sufficient this step was not possible . disease activity of sle and the type of apla ( anti - cardiolipin antibody or lupus anticoagulant ) at the time of stroke were absent in our medical records which might have a correlation with the stroke subtypes . however , the study showed positive apla in sle patients with stroke had more prevalence and was associated with a worse prognosis . according to the significant prevalence of cva among sle patients , cva prevention should start at the early phase of disease and be considered as an essential component of therapeutic strategies . moreover , we showed that the prognosis of cva in iranian sle patients is not unfavorable .