Lambl’s excrescences in a woman with recurrent changes of consciousness

Abstract

Lambl's excrescences are hypermobile long threadlike structures that occur in heart valve closing surfaces. They may originate from fibrin deposits on the injured endothelium, but there is no definitive evidence of association with embolic cerebral stroke. The case of a 56 year-old-woman with liver cirrhosis and recurrent episodes of changes in the consciousness level is described. Shortly after performing liver transplant, she presented an acute ischemic stroke and Lambl's excrescences were incidentally suspected in the aortic valve by transesophageal echocardiography images. The patient had neurological manifestations initially attributed to hepatic encephalopathy, and later defined to be cerebral attacks, with base on studies of magnetic resonance imaging. Although the valvular abnormality can be considered of low embolic potential risk, the possibility of causal relationship was not entirely ruled out in the case herein described. Unsuspected causes of brain embolism may only be cleared by histopathology or necropsy. The aim of this report is to review major features of Lambl’s excrescences, emphasizing diagnostic challenges in the context of cerebral embolism and overt hepatic encephalopathy