Advanced Search. Skip Nav Destination Article Navigation. Close mobile search navigation Article navigation. Volume 42, Issue 7. Previous Article Next Article. Article Navigation. Index of Suspicion July 01 This Site. However, because most of the clinical studies failed to provide an accurate pathologic diagnosis, there is some uncertainty that all the strands were truly LE.
Lambl's excrescences have also been related to valvular stenosis 6 and to the obstruction of coronary ostia in the manifest form of myocardial infarction. Multiple opinions have arisen, mostly from small studies that were not prospective in nature. The main differential diagnosis in suspected cases of LE is fibroelastoma.
Although the gold standard for diagnosis is histopathologic examination of the affected valve a single layer of endothelial cells in diagnosing LE 1 , 8 vs multiple layers in fibroelastoma , certain echocardiographic characteristics can help set the 2 conditions apart Table I.
In , Liu and associates 12 described an association between migraine-like headache that did not completely meet criteria for a specific primary headache and ischemic stroke in 2 patients with LE, a presentation similar to that of our patient. These authors hypothesize that microemboli from an LE cause cerebral ischemia, which presents as a migraine-like headache.
The therapeutic approach to LE should be carefully individualized. In asymptomatic patients, observation is reasonable, but some physicians prefer antiplatelet therapy. If no other embolic sources are found after the first stroke, some authors recommend anticoagulation or antiplatelet therapy. Surgical intervention should be performed in patients who experience recurrent stroke in the absence of an obvious cause and in patients whose LE causes a functional abnormality, such as coronary occlusion that leads to myocardial ischemia or valve obstruction.
Conversely, there is no clear evidence to confute a correlation. The purpose of this report is to bring these circumstances to the attention of the medical community, both to promote further study of LE's significance and to help cardiologists recognize the characteristics of LE on echocardiography.
From: Department of Internal Medicine Dr. Sign In or Create an Account. User Tools. Sign In. Skip Nav Destination Article Navigation. Lansberg, Andrew R. Woofenden, Alexander M. Norbash, Don B. Smith and Gregory B. Headache with neurological deficits and CSF lymphocytosis: A transient ischemic attack mimic. Journal of Stroke and Cerebrovascular Diseases. A migrainous syndrome with cerebrospinal fluid pleocytosis. Neurology ; — Headache Volume 28 , Issue Index. Headache - Volume 16 , Issue Index.
Headache Volume 23 , Issue Index. Headache Volume 26 , Issue Index. Headache Volume 1 , Issue 1. Headache - Volume 14 , Issue Index. Headache Volume 27 , Issue Index. Headache - Volume 13 , Issue Index. Headache - Volume 12 , Issue Index. Headache Volume 1 , Issue 2. Headache Volume 32 , Issue Index. Salciccioli, Thomas J. Seery; Hypertension, Seizure, and Murmur in an year-old Girl. An year-old girl presents to the emergency department for evaluation of acute on chronic headache and new onset vomiting.
Physical examination reveals a weight of The remainder of her physical examination is benign. Computed tomography CT scan imaging of the head is unremarkable.
The hypertension and tachycardia are attributed to pain from the headache, and she is discharged from the emergency department with acetaminophen for the headache and primary care follow-up. Six days later, she returns to the emergency department with complaints of severe headache and vomiting, now Advertising Disclaimer ». Sign In or Create an Account.
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