Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of recurrent cerebral embolism associated with Lambl's excrescence

Yusuke Nakazawa, M.D.1), Junpei Koge, M.D.1), Noritsugu Morishige, M.D, Ph.D.2), Seiya Kato, M.D, Ph.D.3), Masakazu Kawajiri, M.D, Ph.D.1) and Takeshi Yamada, M.D, Ph.D.1)

1) Division of Neurology, Saiseikai Fukuoka General Hospital
2) Department of Cardiovascular Surgery, Saiseikai Fukuoka General Hospital
3) Division of Pathology, Saiseikai Fukuoka General Hospital

A 75-year-old female had a history of prior ischemic stroke with aphasia and right hemiplegia. Magnetic resonance angiography showed left internal carotid artery occlusion. She was successfully treated with intravenous recombinant tissue plasminogen activator (IV t-PA) and underwent endovascular thrombectomy (EVT). She was diagnosed with cardioembolic stroke due to the presence of atrial fibrillation and mitral valve stenosis, and warfarin was administered. However, she experienced large vessel occlusion twice within 2 years. Upon further analysis, transesophageal echocardiography revealed a mobile hyperechoic structure on the aortic valve, which was assumed to be an embolic source. Thus, we decided to perform mitral and aortic valve replacement. The excised aortic valve structure was suggested to be an example of Lambl's excrescence, histopathologically. After surgery, the patient had no recurrence for 3 years. Several cases of ischemic stroke associated with Lambl's excrescence have been reported, but definitive guidelines for managing patients with Lambl's excrescence do not currently exist. Surgical intervention for Lambl's excrescence with recurrent ischemic events may be important for preventing further recurrence.
Full Text of this Article in Japanese PDF (3368K)

(CLINICA NEUROL, 62: 145−151, 2022)
key words: Lambl's excrescence, Warfarin, Transesophageal echocardiography, Cardiac surgery, Mechanical thrombectomy

(Received: 16-Jul-21)