Rare Source of Cardioembolism: Transient Ischemic Attack in a Patient with Lambl's Excrescence

Öztürk, Şule; Aktemur, Tuğba; Kalyoncuoğlu, Muhsin; Durmuş, Gündüz; Can, Mehmet Mustafa

doi:10.5543/tkda.2016.49576

Cited by 3 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Resultsmentioning

confidence: 99%

“…3,8 3D TEE helps in differentiating LE from PFE. 9 Histological evaluation is the confirmatory tool in differentiating a LE from a PFE, where a single endocardial layer covers a LE compared to multiple layers in a PFE. 8 LE is a rare disease with increasing incidence and prevalence attributed to advanced equipment and increased stroke evaluation using echocardiography.…”

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%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Alajjuri,

Alani

2023

Clin Med Insights Case Rep

View full text Add to dashboard Cite

show abstract

“…A total of 92 patients with TIA who underwent treatment from January 2014 to June 2015 in our hospital were recruited, including 47 males and 44 females, aged 22–81 years, average age 54.3±21.3 years, and TIA duration of 6–54 minutes (mean, 40.8±9.2 minutes). All study participants met the diagnostic criteria of TIA [7], and head and neck CTA examination did not find bleeding, occupying lesions, or responsible and symptomatic lesions. The clinical manifestations of patients included single-limb or unilateral weakness, numbness, aphasia or dubbing, dizziness, poor memory, unresponsiveness, and unclear vision.…”

Section: Methodsmentioning

confidence: 99%

Predictive Value of Head-Neck CTA Combined with ABCD2 Scale Score for Patients with Cerebral Infarction of Vertebrobasilar Transient Ischemic Attack (TIA)

Zhang²,

Duan

et al. 2018

Med Sci Monit

View full text Add to dashboard Cite

BackgroundThe present study was designed to evaluate the predictive value of head-neck computed tomography angiography (CTA) combined with ABCD2 score scale for patients with cerebral infarction of vertebrobasilar transient ischemic attack (TIA).Material/MethodsA total of 92 patients with TIA who were admitted to our hospital from January 2014 to June 2015 were enrolled in this study. ABCD2 score and CTA combined with ABCD2 score were assessed.ResultsThe incidence of cerebral infarction was highest in the high-risk group, followed by the middle-risk group and low-risk group. The incidence of cerebral infarction was related to the degree of stenosis in head-neck CTA, which was highest in the severe stenosis group, followed by the moderate stenosis group and mild stenosis/normal group, with significant differences. The incidence of cerebral infarction in patients with cerebral artery stenosis was correlated with the incidence of cerebral infarction in the head and neck CTA, which was severe > medium > normal/low (P<0.05).ConclusionsThe ABCD2 score can accurately predict the early development from TIA to cerebral infarction. If it is used in combination with head-neck CTA; CTA combined ABCD2 score can further improve the accuracy of prediction, which makes it feasible for use in prediction of the development of vertebrobasilar TIA to cerebral infarction.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Rare Source of Cardioembolism: Transient Ischemic Attack in a Patient with Lambl's Excrescence

Cited by 3 publications

References 0 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

Predictive Value of Head-Neck CTA Combined with ABCD2 Scale Score for Patients with Cerebral Infarction of Vertebrobasilar Transient Ischemic Attack (TIA)

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

Contact Info

Product

Resources

About