Abou-El-Hassan Hadi, Azhar Yusra, Ikram Asad, Kulik Tobias, Torbey Michel T
Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
Neurohospitalist. 2024 Jul;14(3):339-346. doi: 10.1177/19418744241240523. Epub 2024 Mar 19.
Lambl's excrescences (LEs) are thin, filiform and hypermobile strands that develop at the valvular coaptation sites of the heart. Since first described in 1856 by Vilém Dušan Lambl, there has been an increasing number of reports of central and peripheral emboli arising from cardiac LEs. LEs have been linked to ischemic strokes irrespective of age and comorbidities. We report one of the youngest reported cases in literature of an embolic stroke in a 25-year-old woman caused by a LE. A comprehensive workup was performed that revealed a large aortic valve LE. The patient was discharged on dual anti-platelet therapy with outpatient cardiology follow-up for surveillance echocardiograms. We then surveyed the literature and reviewed case reports and observational studies of LEs linked to systemic emboli. We found that most LEs are present on left-sided high-pressure valves especially the ventricular aspect of the aortic valves and that most reported cases of cerebral embolism had aortic valve LEs. The management of cardioembolic stroke secondary to LEs remains unclear. LEs have not been identified as a definite etiology of cardioembolic strokes warranting the need for large-scale studies to help guide the management of cardiac LEs in the setting of ischemic stroke.
兰布尔赘生物（LEs）是在心脏瓣膜贴合部位形成的纤细、丝状且活动度高的条索状物。自1856年维莱姆·杜尚·兰布尔首次描述以来，源自心脏LEs的中枢和外周栓塞的报告数量不断增加。无论年龄和合并症如何，LEs都与缺血性中风有关。我们报告了文献中最年轻的由LEs导致栓塞性中风的病例之一，患者为一名25岁女性。进行了全面检查，发现一个大的主动脉瓣LEs。患者出院时接受双联抗血小板治疗，并在门诊接受心脏病学随访以进行超声心动图监测。然后我们查阅了文献，回顾了与系统性栓塞相关的LEs的病例报告和观察性研究。我们发现大多数LEs存在于左侧高压瓣膜上，尤其是主动脉瓣的心室面，并且大多数报告的脑栓塞病例都有主动脉瓣LEs。继发于LEs的心源性栓塞性中风的治疗仍不明确。LEs尚未被确定为心源性栓塞性中风的确切病因，因此需要大规模研究来帮助指导缺血性中风情况下心脏LEs的治疗。
