Lambl’s Excrescences – Taking the Crypto out of Cryptogenic Stroke: A Case Report and Literature Review

Husam M. Salah^1, , David S. Majdalany² and Devon S. Conway³

¹Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, 22110Elective Program, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA, 44195

²Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA, 44195

³Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA, 44195

Cite this paper

Husam M. Salah, David S. Majdalany and Devon S. Conway. Lambl’s Excrescences – Taking the Crypto out of Cryptogenic Stroke: A Case Report and Literature Review. American Journal of Medical Case Reports. 2018; 6(10):214-217. doi: 10.12691/AJMCR-6-10-5

Abstract

Lambl's excrescences (LE) are thin and long filiform projections arising from the line of closure of cardiac valves. Their etiology is not well understood, but they’re thought to result from a wear-and-tear process. They are typically asymptomatic and best detected by transesophageal echocardiogram. Although controversial, some studies suggest an association between LE, ischemic stroke, and headaches. We describe a 56-year-old man who presented with a 3-day history of bilateral blurry vision within the left visual field. One day prior to his visual symptoms, he developed a severe headache that persisted until his presentation to our hospital. On physical examination, visual acuity and fields were intact, but he reported blurriness in the left visual field of both eyes. Brain MRI showed a wedge-shaped area of restricted diffusion along the medial aspect of the right occipital lobe, indicating an ischemic stroke of the visual cortex. Due to the embolic appearance of the stroke, transesophageal echocardiogram was performed and showed a LE on the aortic valve. No other embolic source was identified. In the absence of another explanation for his stroke, LE was considered the most likely source of his embolic stroke. The patient was treated with antiplatelet therapy. In conclusion, this case report highlights LE as a possible cardioembolic source of stroke and discusses its association with headache. We also provide a review of the current literature on LE and the lack of clear guidelines on its management.

Keywords

Cerebrovascular disease, Stroke, Embolism, Cardiac, Cardioembolic stroke, Lambl’s Excrescences, Headache

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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