Abstract Details

Title The Black Sheep of Stroke Etiologies: Visual Abnormalities and Cerebral Infarction in Association with Lambl’s Excrescences

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-069

Objective NA

Background 71 year old right-handed woman with a history of hypertension and hyperlipidemia presented following two episodes of transient monocular vision loss. The patient described an ascending partial loss of monocular vision in her right eye lasting ~1 minute. In both cases, the patient denied preceding palpitations or associated symptoms. No reported additional neurologic symptoms throughout or following the episode. Patient was seen by her ophthalmologist who reported no abnormalities on dilated eye exam and recommended evaluation for amaurosis fugax.

Design/Methods NA

Results Initial differential included amaurosis fugax due to cardioembolism, transient occipital ischemia, cerebral small vessel disease, and intraorbital pathology. Neurologic examination and ophthalmologic assessment were without abnormality. MRI brain showed multiple punctate acute infarcts in the cerebral hemispheres and right cerebellum. MRA brain/neck was without abnormality. Transthoracic echocardiogram showed a linear mobile filamentous structure attached to the aortic valve, consistent with Lambl's excrescence. Telemetry showed no evidence of arrhythmia. Cardiology and cardiothoracic surgery recommended anticoagulation with potential surgical management of valvular pathology should patient manifest additional infarcts.

Conclusions Lambl’s excrescences are a rare source of cardioembolic disease. These filiform lesions on the aortic valve are thought to result from wear and tear. While this patient had multifocal punctate infarcts across multiple vascular distributions consistent with a central cardioembolic source, these infarcts may not completely explain her presenting symptoms. Thus, amaurosis fugax remains within the descriptive differential. Data regarding stroke in association with Lambl’s excrescences is limited, and there appears to be no prior cases presenting with acute visual changes. While there are well established protocols as it pertains to management of patients who present with symptoms of stroke/TIA, it is important to consider both the non-traditional as well as the expected etiologies of symptoms. Further research is warranted as it pertains to long-term management of symptomatic Lambl’s excrescences associated with stroke.

Authors/Disclosures
Micah Etter, MD (University of Arizona Neurology) PRESENTER	Dr. Etter has nothing to disclose.
Preeth Manu, MD (Medical College of Georgia at Augusta University)	No disclosure on file
Chelsea S. Kidwell, MD (University of Arizona Department of Neurology)	No disclosure on file

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