Lambl's excrescence, migrainous headaches, and "tiger stripes": puzzling findings in one patient

Lambl's excrescences are mobile, thin, filiform structures that occur at sites of valve closure. Even though many clinicians consider them to be part of the normal aging process, evidence suggests an association between Lambl's excrescences and ischemic stroke, migrainous headaches, and acute coronary syndromes. As a thin filamentous structure, a Lambl's excrescence is better detected and characterized with transesophageal than with transthoracic echocardiography. Intracardiac oscillatory structures can also be seen as "tiger stripes" on spectral pulsed Doppler echocardiographic recordings. Herein, we present the case of a 68-year-old woman who had 3 concurrent enigmatic findings with unclear correlation: migrainous headaches, Lambl's excrescences, and the uncommon finding of "tiger stripes" on spectral Doppler echocardiography. We discuss the possible correlation between these 3 findings and review the available literature on Lambl's excrescences and tiger stripes.