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14 December 2015 : Case report  USA

Lambl’s Excrescence Associated with Cryptogenic Stroke: A Case Report and Literature Review

Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Andrew ChuBCDEF, Thu Thu AungBCDF, Haim SahalonCDE, Vivek ChoksiEF, Hamid FeizE

DOI: 10.12659/AJCR.895456

Am J Case Rep 2015; 16:876-881

Abstract

BACKGROUND: In 1856, a Bohemian physician, Vilém Dušan Lambl, first described the presence of filiform lesions in aortic valve leaflets. Lambl’s excrescences are tiny filiform strands that arise on the line of valve closure, and result from valvular wear and tear. It is a rare cause of cardioembolic stroke that can be detected by transesophageal echocardiogram.

CASE REPORT: We encountered a 51-year-old, African-American woman with a history of recurrent strokes that we suspect may be the result of Lambl’s excrescence. The patient was treated with dual antiplatelet therapy and was recommended to have surveillance transesophageal echocardiograms at 6 months and 1 year from the time of discharge.

CONCLUSIONS: As there are no definitive guidelines for the management of patients with Lambl’s excrescences, we present a review of the current medical literature and a specific case report in an attempt to provide a better strategy for managing this condition. In our case report, we focus on the management and treatment for Lambl’s excrescence because no clear evidence has been published in the literature. Our review indicates that Lambl’s excrescence, despite its relative scarcity, should be considered in the differential diagnosis of a patient with cryptogenic stroke.

Keywords: Aortic Valve - ultrasonography, Echocardiography, Transesophageal, Heart Valve Diseases - ultrasonography, Ischemic Attack, Transient - etiology, Magnetic Resonance Imaging, Platelet Aggregation Inhibitors - therapeutic use

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923