Valvular Strands: A Rare Cause for Stroke in a Young Patient

Kitchloo, Karishma; Lam, Pang; Saxena, Abhinav; Yoon, Taek; Seneviratne, Chanaka; Kupfer, Yizhak

doi:10.1378/chest.2281759

Cited by 2 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

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

show abstract

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

Valvular Strands: A Rare Cause for Stroke in a Young Patient

Cited by 2 publications

References 0 publications

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

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

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

Contact Info

Product

Resources

About