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An Unusual Source of Cerebral Embolism

N. Nighoghossian, MD; L. Derex, MD; R. Loire, MD; M. Perinetti, MD; J. Honnorat, MD; G. Riche, MD; M. Barthelet, MD; J. Ninet, MD; G. Chazot, MD; J. Chassignolle, MD; P. Trouillas, MD, PhD

Arch Neurol. 1997;54(1):41-44.

Abstract
Background
A possible association of giant Lambl excrescences (LEs) with stroke has been suggested. However, the treatment of giant LEs is controversial because minimal data are available.

Objective
To clarify the management of giant LEs through a clinicopathologic study.

Case Series
Three young patients (2 women and 1 man) who experienced ischemic stroke were studied. Results of general examinations were normal, as were chest X-ray films, electrocardiograms, ultrasonograms of the neck, and cerebral angiograms. Extensive serological and blood testing failed to show any coagulopathies or systemic disorders that favored a stroke in these patients. Transesophageal echocardiography showed a mitral valve lesion (width, >1 mm). Two patients (cases 1 and 3) were discharged on a regimen of anticoagulant therapy and sequential transesophageal echocardiographic monitoring was planned, whereas 1 patient (case 2) was promptly scheduled for surgery. A second stroke occurred in patients 1 and 3 at 3 and 6 months, respectively, thus leading to surgery in these 2 patients. Findings from histopathologic studies were consistent with the diagnosis of giant LEs. The patients' outcomes were uneventful after surgery, and none had a recurrence of a stroke.

Conclusions
A relationship between giant LEs and stroke may be suggested. In patients who have transesophageal echocardiographic findings that are consistent with this diagnosis and recurrent stroke despite antithrombotic therapy and without an alternative explanation for the ischemic symptoms, surgery should be considered in view of these findings.

Author Affiliations
From the Department of Neurology, Cerebrovascular Disease and Ataxia Research Center (Drs Nighoghossian, Derex, Honnorat, Riche, and Trouillas), and the Department of Neurology C (Dr Chazot), Pierre Wertheimer Hospital, Lyon, France; and the Departments of Anatomic Pathology (Dr Loire), Cardiac Surgery C (Dr Ninet), and Cardiac Surgery A (Dr Chassignolle) and the Echocardiography Laboratory (Drs Perinetti and Barthelet), Louis Pradel Hospital, Lyon.

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