Zusammenfassung
Wir berichten über eine 47-jährige Patientin mit einer Ischämie im linken Stromgebiet der A. cerebri media. Im Rahmen der Zusatzdiagnostik zeigte die transösophageale Echokardiographie eine filiforme, hypermobile Struktur an der Aortenklappe, die als Lambl-Exkreszenz gewertet wurde. Lambl-Exkreszenzen wurden mit einem gehäuften Auftreten zerebraler Ischämien assoziiert, obwohl der genaue Pathomechanismus bisher noch nicht näher bestimmt werden konnte. Das therapeutische Vorgehen nach einem ischämischen Ereignis besteht derzeit aus einer Sekundärprophylaxe mittels Thrombozytenaggregationshemmung. Eine operative Intervention kann anhand der gegenwärtigen Datenlage nicht generell empfohlen werden.
Summary
We report a previously healthy 47-year-old woman suffering acute embolic stroke in the left middle cerebral artery distribution. A filiform hypermobile mass along the line of the aortic valve representing a Lambl’s excrescence was first identified by transesophageal echocardiography. Lambl’s excrescences are structures attached to the edges of cardiac valves that have been associated with stroke, although their exact pathogenetic mechanisms have not yet been established. Further, treatment after cryptogenic stroke associated with presence of a valvular strand is based on platelet inhibition. Following currently available evidence, surgery cannot be generally recommended for this condition.
Literatur
Al-Mohammad A, Pambakian H, Young C (1998) Fibroelastoma: case report and review of the literature. Heart 79:301–304
Fox E, Brunson C, Campbell W et al. (2006) Cardiac papillary fibroelastoma presents as an acute embolic stroke in a 35-year-old African American male. Am J Med Sci 331:91–94
Freedberg RS, Goodkin GM, Perez JL et al. (1995) Valve strands are strongly associated with systemic embolization: a transesophageal echocardiographic study. J Am Coll Cardiol 26:1709–1712
Gowda RM, Khan IA, Nair CK et al. (2003) Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 146:404–410
Grandmougin D, Fayad G, Moukassa D et al. (2000) Cardiac valve papillary fibroelastomas: clinical, histological and immunohistochemical studies and a physiopathogenic hypothesis. J Heart Valve Dis 9:832–841
Homma S, Di Tullio MR, Sciacca RR et al. (2004) Effect of aspirin and warfarin therapy in stroke patients with valvular strands. Stroke 35:1436–1442
Margarey FR (1949) On the mode of formation of Lambl’s excrescences and their relation to chronic thickening of the mitral valve. J Pathol 61:203–208
Nighoghossian N, Derex L, Loire R et al. (1997) Giant lambl excrescences. An unusual source of cerebral embolism. Arch Neurol 54:41–44
Sun JP, Asher CR, Yang XS et al. (2001) Clinical and echocardiographic characteristics of papillary fibroelastoma. A retrospective and prospective study in 162 patients. Circulation 103:2687–2693
Voros S, Nanda NC, Thakur AC et al. (1999) Lambl’s excrescences (valvular strands). Echocardiography 16:399–414
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wolf, R.C., Spieß, J. & Huber, R. Lambl-Exkreszenzen und zerebral-ischämischer Insult. Nervenarzt 77, 1492–1494 (2006). https://doi.org/10.1007/s00115-006-2198-4
Issue Date:
DOI: https://doi.org/10.1007/s00115-006-2198-4