Accidente isquémico transitorio secundario a excrecencia de Lambl: Descripción de un caso y revisión de la literatura

Rubio, Juan Ramón Siles; Campo, J. Ruiz de Castroviejo del; Miranda, Rogério; Chaparro, S. Jansen; Pavlović, Dragan

doi:10.4321/s0212-71992006000400009

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…In our case, alternative causes were ruled out (negative EKG, hypercoagulability panel, carotid US, and arrhythmias), leading us to suggest that LEs may have been responsible for our patient’s presentation. This is in line with previous case reports documenting a similar association [ 3 , 4 – 6 , 13 , 15 – 17 , 21 , 23 , 24 ]. However, for our patient, the first episode of stroke was diagnosed as cryptogenic stroke and no TEE workup was done at that time.…”

Section: Discussionsupporting

confidence: 93%

“…Aortic and mitral valves were the two most common locations of LE. However, ischemic events were more commonly observed in association with LEs on aortic valves [ 3 , 5 , 6 , 8 , 15 – 17 , 20 , 21 , 23 , 24 ] as compared to mitral valves [ 4 , 13 ]. Although there has been some case reports on giant LEs (≥2 cm in diameter) associated with ischemic stroke [ 6 , 15 ], no clear evidence exists in the literature showing the correlation between the strand size and potential risk of thromboembolic event.…”

Section: Discussionmentioning

confidence: 99%

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Lambl’s Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review

et al. 2015

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Patient: Female, 51Final Diagnosis: Transient ischemic attackSymptoms: Unilateral left-sided weakness and slurred speechMedication: Lisinopril 20 mg dailyClinical Procedure: Transesophageal echocardiogramSpecialty: Cardiology • NeurologyObjective:Rare diseaseBackground:In 1856, a Bohemian physician, Vilém Dušan Lambl, first described the presence of filiform lesions in aortic valve leaflets. Lambl’s excrescences are tiny filiform strands that arise on the line of valve closure, and result from valvular wear and tear. It is a rare cause of cardioembolic stroke that can be detected by transesophageal echocardiogram.Case Report:We encountered a 51-year-old, African-American woman with a history of recurrent strokes that we suspect may be the result of Lambl’s excrescence. The patient was treated with dual antiplatelet therapy and was recommended to have surveillance transesophageal echocardiograms at 6 months and 1 year from the time of discharge.Conclusions:As there are no definitive guidelines for the management of patients with Lambl’s excrescences, we present a review of the current medical literature and a specific case report in an attempt to provide a better strategy for managing this condition. In our case report, we focus on the management and treatment for Lambl’s excrescence because no clear evidence has been published in the literature. Our review indicates that Lambl’s excrescence, despite its relative scarcity, should be considered in the differential diagnosis of a patient with cryptogenic stroke.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Lambl’s Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review

et al. 2015

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“…Given the rarity of this phenomenon, there are no guidelines on treatment of patients with LE. Currently based on the available case reports treatment varies from antiplatelet therapy with single or dual agents in patients with single embolic phenomenon [18][19][20]. In cases with recurrent embolic phenomenon, the standard of treatment tends to be either anticoagulants or surgery [3,13,14].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity

Ramanan,

Singh,

Ahmed

et al. 2023

Cureus

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Lambl's excrescences (LE) are mobile filiform lesions, mostly found on the left-sided heart valves. Histologically, they have a mesenchymal origin with a single endothelial layer. They have the potential to detach, resulting in catastrophic thromboembolic events. Their rarity often leads to them being misdiagnosed as vegetations of endocarditis with patients failing to improve on conventional therapy.A 48-year-old female with a history of hypertension presented to the Emergency Department with a oneweek history of sharp left upper quadrant pain. She was vitally stable; the only lab abnormality was revealed to be a mildly elevated white cell count. CT abdomen revealed a splenic infarct involving 25% of the parenchyma. Patients had no history of abdominal trauma, coagulation disorders, exogenous estrogen use or IV drug abuse. Subsequent investigations failed to reveal any cause of hypercoagulability. An extensive cardiac workup revealed no arrhythmias, but transesophageal echocardiogram showed a mobile echo density on the ventricular side of the aortic valve attached at the coaptation zone, approximately 2.7 cm long and 0.1 cm wide, suggesting a very prominent Lambl's excrescence. In the absence of any other findings, the patient's splenic infarct was determined to be secondary to an embolic event from the aortic valve lesion. Rivaroxaban was initiated and the patient subsequently improved.Existing literature describes most LEs as being asymptomatic and discovered incidentally on echocardiograms. This case illustrates the need to develop a criterion for prompt identification of LEs and differentiating them from the vegetations of endocarditis. It also brings forth the question of prophylactic treatment of these lesions while highlighting the lack of guidelines regarding the management of embolic phenomena secondary to LE.

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“…9 Mechanistically, due to valvular wear and tear, LEs form on affected valves and act as a nidus for thrombi to accumulate that embolize centrally and peripherally. Although their definite prevalence in asymptomatic patients is unknown, an increasing number of case reports and observational studies have associated LEs with cerebral embolism, 5-7,10-42 acute coronary syndrome, 43-47 peripheral embolism, 19 myocarditis 48 and fatigue 49 in addition to LEs as incidental findings. 50-53 Here, we conduct a comprehensive literature review of reported cases and observational studies pertaining to embolic events associated with LE.…”

Section: Introductionmentioning

confidence: 99%

A Large Lambl’s Excrescence Causing Embolic Stroke in a Young Patient: A Case Report and Review of Literature

Abou-El-Hassan,

Azhar,

Ikram

et al. 2024

The Neurohospitalist

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Lambl’s excrescences (LEs) are thin, filiform and hypermobile strands that develop at the valvular coaptation sites of the heart. Since first described in 1856 by Vilém Dušan Lambl, there has been an increasing number of reports of central and peripheral emboli arising from cardiac LEs. LEs have been linked to ischemic strokes irrespective of age and comorbidities. We report one of the youngest reported cases in literature of an embolic stroke in a 25-year-old woman caused by a LE. A comprehensive workup was performed that revealed a large aortic valve LE. The patient was discharged on dual anti-platelet therapy with outpatient cardiology follow-up for surveillance echocardiograms. We then surveyed the literature and reviewed case reports and observational studies of LEs linked to systemic emboli. We found that most LEs are present on left-sided high-pressure valves especially the ventricular aspect of the aortic valves and that most reported cases of cerebral embolism had aortic valve LEs. The management of cardioembolic stroke secondary to LEs remains unclear. LEs have not been identified as a definite etiology of cardioembolic strokes warranting the need for large-scale studies to help guide the management of cardiac LEs in the setting of ischemic stroke.

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Accidente isquémico transitorio secundario a excrecencia de Lambl: Descripción de un caso y revisión de la literatura

Cited by 7 publications

References 10 publications

Lambl’s Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review

Lambl’s Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review

A Rare Case of Splenic Infarct Secondary to Mobile Cardiac Echodensity

A Large Lambl’s Excrescence Causing Embolic Stroke in a Young Patient: A Case Report and Review of Literature

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