Giant lambl excrescences. An unusual source of cerebral embolism
N. Nighoghossian, L. Derex, R. Loire, M. Perinetti, J. Honnorat, G. Riche, M. Barthelet, J. Ninet, G. Chazot, J. Chassignolle and P. Trouillas
Department of Neurology, Pierre Wertheimer Hospital, Lyon, France.
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.
