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An Unusual Cardiac Cause of Stroke
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A6883 - An Unusual Cardiac Cause of Stroke
Author Block: C. Jacob, A. Al-Khateeb, S. Sivsammye, P. Patel; Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, United States.
Lambl’s excrescences are rare lesions found on heart valves. We present a case of a 75 year old woman admitted with embolic strokes secondary to aortic valve Lambl’s excrescences.
A 75 year old woman with a history of breast cancer and hypertension presented with altered mental status. A brain MRI showed several small infarcts in the right occipital lobe and right cerebellum and chronic hemosiderin within the cerebellum and left occipital and parietal lobes. A transthoracic echocardiogram was performed which appeared to show aortic valve sclerosis, and mitral valve systolic bowing without prolapse. A transesophageal echocardiogram was performed to further investigate the valvular defects and showed Lambl’s excrescences on the right and non-coronary cusps of the aortic valve. She had no evidence of atrial fibrillation or atrial septal defect. Given the presence of Lambl’s excrescences with strokes, she was started on coumadin. She was discharged with continued physical therapy rehabilitation with improvement in her mentation back to baseline.
Lambl’s excrescences are filiform lesions found most commonly on the aortic valve leaflets, similar to cardiac papillary fibroelastomas but found at sites of valve closure. They are a rare cause of systemic embolism, previously related to both strokes and myocardial infarctions. Transesophageal echocardiography is an important modality in diagnosing Lambl’s excrescences, and evaluating for sources of systemic embolization, as they may not be visualized on transthoracic echocardiography. All patients with Lambl’s excrescences should be placed on antiplatelet therapy. After a stroke, they should be treated with anticoagulation. A recurrent stroke while on anticoagulation should be treated with surgical excision. Lambl’s excrescences represent a rare, but important, possible etiology of embolism that must be considered in the evaluation of ischemic stroke.
Author Block: C. Jacob, A. Al-Khateeb, S. Sivsammye, P. Patel; Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, United States.
Lambl’s excrescences are rare lesions found on heart valves. We present a case of a 75 year old woman admitted with embolic strokes secondary to aortic valve Lambl’s excrescences.
A 75 year old woman with a history of breast cancer and hypertension presented with altered mental status. A brain MRI showed several small infarcts in the right occipital lobe and right cerebellum and chronic hemosiderin within the cerebellum and left occipital and parietal lobes. A transthoracic echocardiogram was performed which appeared to show aortic valve sclerosis, and mitral valve systolic bowing without prolapse. A transesophageal echocardiogram was performed to further investigate the valvular defects and showed Lambl’s excrescences on the right and non-coronary cusps of the aortic valve. She had no evidence of atrial fibrillation or atrial septal defect. Given the presence of Lambl’s excrescences with strokes, she was started on coumadin. She was discharged with continued physical therapy rehabilitation with improvement in her mentation back to baseline.
Lambl’s excrescences are filiform lesions found most commonly on the aortic valve leaflets, similar to cardiac papillary fibroelastomas but found at sites of valve closure. They are a rare cause of systemic embolism, previously related to both strokes and myocardial infarctions. Transesophageal echocardiography is an important modality in diagnosing Lambl’s excrescences, and evaluating for sources of systemic embolization, as they may not be visualized on transthoracic echocardiography. All patients with Lambl’s excrescences should be placed on antiplatelet therapy. After a stroke, they should be treated with anticoagulation. A recurrent stroke while on anticoagulation should be treated with surgical excision. Lambl’s excrescences represent a rare, but important, possible etiology of embolism that must be considered in the evaluation of ischemic stroke.
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