Abstract Details

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

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 110

Objective To report a case and conduct literature review investigating the association between Lambl’s excrescences (LEs) and ischemic stroke.

Background Lambl’s excrescences (LEs) are thin, filiform and hypermobile strands that develop at the valvular coaptation sites of the heart. Valvular LEs are rare but represent a possible cause of cardioembolic stroke. Mechanistically, due to valvular wear and tear, LEs form on affected valves and act as a nidus for embolic thrombi.

Design/Methods We report the youngest case in literature of an embolic stroke in a 25-year-old woman caused by a large aortic valve LE. A comprehensive workup was performed. Non-contrast head CT showed no acute changes after which the patient was given tPA. Brain magnetic resonance imaging (MRI) showed right distal anterior cerebral artery (ACA) territory infarction. Brain magnetic resonance venography, carotid Doppler, transcranial Doppler as well as autoimmune and hypercoagulable studies were unremarkable. The patient was discharged on dual anti-platelet therapy and cardiology follow-up with surveillance echocardiograms. We then surveyed the literature and reviewed case reports and observational studies of LEs linked to systemic emboli.

Results In our literature review, we found that LEs occur more often in mid-aged adults 41-50 years-old (26.6%). Most LEs exist on left-sided high-pressure valves: the ventricular aspect of the aortic valve (80%) and, less often, the atrial aspect of the mitral valve (17.7%). We found that most case reports of cerebral embolism had aortic valve LEs (69.6%), similar to our reported case. The majority of LE-induced first embolic events were treated with mono/dual antiplatelet therapy (42.9%) whereas surgical excision was performed in cases of recurrent embolic events.

Conclusions The management of cardioembolic stroke secondary to LEs remains unclear. LEs have not been yet identified as a definite etiology of cardioembolic stroke. Large-scale studies are warranted to guide the management of LE-induced ischemic stroke.

Authors/Disclosures
Hadi Abou-El-Hassan, MD PRESENTER	Dr. Abou-El-Hassan has nothing to disclose.
	No disclosure on file
Asad Ikram, MD, MBBS	Dr. Ikram has nothing to disclose.
Dmitry Belchenko, DO (Community Health Partners)	Dr. Belchenko has nothing to disclose.
Tobias B. Kulik, MD, FAAN (University of New Mexico)	Dr. Kulik has nothing to disclose.
Michel T. Torbey, MD, MPH, FAAN (University of Oklahoma)	Dr. Torbey has nothing to disclose.

��ɫ��

��ɫ��