Recurrent Cardio-embolic Cerebrovascular Accidents due to Lambl's Excrescences?

Abstract

Cerebrovascular accidents (strokes) are leading cause of morbidity and mortality in the United States of America. Cardioembolic strokes account for one-third of cerebrovascular accidents. Lambl’s excrescences are filiform projections on the native cardiac valves; they are attributed as a rare cause of cardioembolic strokes. They are a result of endothelial damage secondary to valve wear and tear. Lambl’s excrescences as a cause of cardioembolic stroke is debated. Lambl’s excrescences are a frequent appearance on echocardiography. We here present a case of recurrent cardioembolic strokes in whom lambl’s excrescences on aortic valves were detected on transesophageal echocardiography. Previous transthoracic echocardiography in the patient had not revealed lambl’s excrescences owing to their low sensitivity. Patient refused aortic valve replacement and medical management of cerebrovascular accident was continued.