Cryptogenic Stroke and Valvular Strands

Abstract

Background: Ischaemic stroke can be classified according to its aetiology. In cryptogenic stroke, Lambl's excrescences should be considered since they can only be detected through transesophageal echocardiography (TEE), which is not routinely performed.

Case description: The authors report the case of a 63-year-old Caucasian man with two ischaemic cerebral events associated with the presence of Lambl's excrescences in the aortic valve detected with TEE. Switching antiaggregant therapy to anticoagulant therapy allowed the patient to remain asymptomatic throughout a 3-year follow-up.

Conclusion: The lack of protocols for the management of cryptogenic stroke results in a delay in the identification of less frequent causes of stroke, leading to recurrent vascular events, morbidity and loss of functionality. The authors describe a patient who experienced multiple cerebral ischaemic events until the correct diagnosis was made.

Learning points: Lambl's excrescences are a considered a rare cause of embolic stroke, probably because they are underdiagnosed.The pathophysiology is not fully understood, making therapeutic decisions difficult.Early recognition and management of this structural valve disease can prevent life-threatening complications.

Keywords: Thrombosis; inferior vena cava syndrome; lumbar pain; nephroblastoma.

Figure 1

Transesophageal echocardiogram showing a 4 mm strand adherent to the aortic valve in mid-oesophageal long-axis view (arrow) Ao, aortic root; LV, left ventricle