Lambl’s Excrescences Associated with Cardioembolic Stroke

Shrestha, Biraj; Pokhrel, Arpan; Oke, Ibiyemi; Paudel, Anish; Timlisina, Bidhya; Parajuli, Prem Raj; Basnet, Sijan; Poudel, Bidhya

doi:10.12659/ajcr.934859

Cited by 5 publications

(12 citation statements)

References 10 publications

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“…6 CVA recurrence rate is estimated at around 30% in patients with LE after the second thromboembolic attack, leading to the consideration of the surgical approach. 1 Patients not adherent to medical therapy should be offered surgical excision and valve replacement after a CVA or a TIA. 3 Management should be individualized for each patient, considering antiplatelets, anticoagulants, and surgical risks and benefits.…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…6 It was found that thromboembolic risks are independent of excrescences sizes. 1 A giant LE result when multiple adjacent excrescences join and form a complex. 6 Excrescences tend to occur in healthy people with increasing incidence with aging, where prevalence peaks between the age of 61 and 70, and then drops due to increased valve calcification, resulting in excrescences being masked under echocardiography.…”

Section: Introductionmentioning

confidence: 99%

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

Alajjuri,

Alani

2023

Clin Med Insights Case Rep

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Lambl’s excrescence (LE), a rare thin linear fibrous thread of collagen and elastic fibrous tissue originating at closure margins of heart valve leaflets is considered a rare cause of thromboembolism, causing ischemic stroke, transient ischemic attack (TIA), acute coronary syndrome, or peripheral thromboembolism. The gold standard for diagnosing LE is transesophageal echocardiography (TEE). Due to the rarity of the disease and lack of significant research, no guidelines exist about the management of LE. Twenty-two papers about LE were reviewed, focusing on the management aspect aiming to assist in guideline publication. Articles were retrieved using PubMed database using “Lambl’s excrescences” as a keyword. All free full text papers up to 2023 were retrieved. In this report, we present the first publication of a case of a TIA secondary to LE in the United Arab Emirates. A 53-year-old male presented with transient attacks of left monocular blindness with complete recovery 2 days later. Extensive stroke work-up was negative, except for TEE, which showed an echo-dense linear mobile structure attached to the aortic surface of the aortic valve closure margin, suggesting LE. As no guidelines exist on the management of LE, the patient was started on Clopidogrel 75 mg daily and remained asymptomatic for 2 years. After reviewing the literature, we suggest the use of Aspirin for patients with ⩾1 embolic event attributed to LE while not on antiplatelets or anticoagulants, as it is the most used and recommended treatment option and is effective in preventing recurrent thromboembolic events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Alajjuri,

Alani

2023

Clin Med Insights Case Rep

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“…The latter may be caused by blockages in small blood vessels of the brain, arterial embolisms from cardiac sources, or atherosclerosis of the cerebral circulation [ 1 ]. Heart-related causes account for 14%-30% of ischemic strokes [ 2 ]. Over the past few decades, stroke incidence has decreased overall; however, strokes caused by cardiac sources have doubled [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

An Unusual Source of Cerebral Embolism Caused by Lambl’s Excrescences

Hakobyan,

Ilerhunmwuwa,

Wasifuddin

et al. 2023

Cureus

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Lambl's excrescences (LEs) are delicate filiform strands formed by connective tissue located along the valve closure lines within the cardiovascular system. Most cases of these excrescences manifest without discernible symptoms, and the exact etiological factors contributing to their formation remain unknown. These excrescences may embolize to the brain, causing strokes. It is essential that all other possible causes of stroke be eliminated prior to identifying Lambl's excrescences as the cause of the stroke. Herein, we present a case of a patient who suffered a stroke, and all conventional testing for common causes of embolic strokes was ruled out. In pursuit of a comprehensive evaluation encompassing the classification of the stroke as cryptogenic, a transesophageal echocardiogram (TEE) was performed, which effectively disclosed the existence of LEs situated on the aortic valve leaflets. The patient was treated with anticoagulation and discharged with close follow-up monitoring. To culminate, the inclusion of this case within our study augments the currently scarce pool of instances that exhibit such characteristic cardioembolic phenomena, thereby accentuating the necessity for additional prospective investigations to substantiate the existence of a causative association linking LEs and cardioembolic strokes.

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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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Lambl’s Excrescences Associated with Cardioembolic Stroke

Cited by 5 publications

References 10 publications

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

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

An Unusual Source of Cerebral Embolism Caused by Lambl’s Excrescences

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

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