Lambl's Excrescences Associated With Left Frontal Ischemic Stroke: A Case Report

Abstract

Lambl's excrescences (LEs) are thin filiform strands of connective tissue found on the closure line of valves. Their exact etiology is unknown, and most of them are typically asymptomatic. We present a case of a 33-year-old African American male with a history of right upper extremity weakness that resolved on its own within a few minutes. On physical examination, no focal neurologic deficit was observed. MRI brain showed a tiny curvilinear focus of restricted diffusion with subtle T2-FLAIR hyperintensity in the left frontal/insular region, indicating a recent cortical infarct. Transesophageal echocardiogram (TEE) was performed as a part of cryptogenic stroke workup, which showed LE on aortic valve leaflet tips. Our patient had elevated blood pressure (BP) on arrival; however, in LE's presence, the embolic phenomena of stroke cannot be excluded. In conclusion, this case adds to a limited number of cases with such cardioembolic phenomena, which will help in further illustrating and highlighting the need for more prospective studies to establish a causal relationship between LE and cardioembolic strokes.

Lambl’s Excrescence as an Etiology of Thromboembolism: Case Report and Literature Review

“…12 While most LEs are asymptomatic and found incidentally on echocardiography or autopsy, they are considered as a rare cause of thromboembolism, commonly from the aortic valve, either through fragmentation or microthrombi formation on top of the lesions, leading to ischemic stroke, TIA, acute coronary syndrome, or peripheral thromboembolism (retinal, renal, popliteal). [1][2][3][4][5][6][7][8][9][10][12][13][14][15][16][17] A study involving 224 patients with recent stroke and 85 controls found LE present in 74 patients (33%) compared to only 6 patients (7.1%) from the control group. 18 It was concluded that LE is strongly associated with recent ischemic strokes in a multivariate analysis (odds ratio: 6.93, 90% confidence interval: 3.18-15.12; P-value < .001).…”

“…According to the Centers for Disease Control and Prevention (CDC), ischemic pathologies contribute to 87% of strokes in the United States, of which 14%-30% are found to be from a cardiac source, while 24%-28% are cryptogenic in origin. 1 , 2 Lambl’s Excrescences (LEs) were first reported in 1856 by the physician Vilém Dušan Lambl. 3 They are rare single or multiple thin linear mobile fibrous threads originating at valve leaflets closure margins usually at the Arantius nodules, measuring ⩽2 mm in thickness and ⩾3 mm in length without gender predominance.…”

“…University of Sharjah, Sharjah, United Arab Emirates 2. Al Qassimi Hospital, Sharjah, United Arab Emirates 3.…”