SHM Converge Scientific Abstract ePoster Gallery-Lambls Excrescences Presenting as a Rare Cause of Cryptogenic Stroke.

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This case describes a 46-year-old man with smoking history who presented with sudden right-sided weakness, numbness, and facial droop while playing video games. His NIH Stroke Scale score was 12. Initial CT head and CTA head/neck were negative, but he received tenecteplase for suspected acute ischemic stroke with rapid neurologic improvement. MRI later confirmed an acute cortical infarction in the left temporal and parietal lobes.<br /><br />Because the stroke was cryptogenic in a relatively young patient without typical vascular risk factors, a broad workup was performed. Transthoracic echocardiogram was normal and showed no PFO. Diabetes, inflammatory markers, infectious testing, and hypercoagulable studies were unrevealing. Transesophageal echocardiogram, however, revealed a small mobile echogenic structure on the anterior mitral valve leaflet, suspicious for Lambl’s excrescence (LE), a rare valvular strand thought to arise from degenerative wear and tear and capable of causing embolic events.<br /><br />No arrhythmias were detected on post-discharge Zio monitoring. Neurology recommended lifelong anticoagulation starting five days after stroke, and the patient was discharged on rivaroxaban and high-intensity statin therapy with cardiothoracic surgery follow-up.<br /><br />The report emphasizes that Lambl’s excrescences are an underrecognized cause of cardioembolic stroke, especially in younger patients with few traditional risk factors. Diagnosis relies mainly on TEE, since LE may be missed on routine testing. There are no consensus treatment guidelines; anticoagulation is generally used after a first embolic event, while surgery is considered for recurrent strokes or large symptomatic lesions. The authors conclude that clinicians should maintain high suspicion for LE in cryptogenic stroke and that further research is needed to guide management.

Asset Subtitle

Maninderjit Singh

Meta Tag

Author List Maninderjit Singh, Sobia Syed, Syed Shah

Category Clinical Vignettes

Concept Lambls Excrescences

Concept Cryptogenic Stroke

Concept Cardioembolic Stroke

Concept Transesophageal Echocardiography

Concept Brain Imaging

Distinguished Non-Finalist

Presenter Organization Saint Michael Medical Center

Presenting Author Maninderjit Singh

Track Adult

Keywords

cryptogenic stroke

Lambl’s excrescence

transesophageal echocardiogram

cardioembolic stroke

acute ischemic stroke

tenecteplase

mitral valve leaflet

rivaroxaban

young patient

hypercoagulable workup

Lambls Excrescences

Cryptogenic Stroke

Cardioembolic Stroke

Transesophageal Echocardiography

Brain Imaging