Migraine-like headache and ischemic strokes in two patients with Lambl's excrescences.

Lambl's excrescences are filiform structures attached to the edges of cardiac valves and have been associated with stroke. Here we report two patients with Lambl's excrescences who developed migraine-like headaches followed by cerebral infarction. Their Lambl's excrescences were first identified by transesophageal echocardiography. One patient was given aspirin and another had surgery for debridement of excrescences. Their outcomes were good. The migraine-like headache might be the first symptom of cerebral ischemia and might be triggered by micro-emboli originated from Lambl's excrescences. Patients with Lambl's excrescences should be closely monitored and surgery should be considered in recurrent stroke cases.