Unilateral orolingual angioedema after thrombolysis in a patient with cerebrovascular ischemia

Excerpt

A 67-year-old male presented at the Emergency Department with a right-sided hemiparesis. The patient’s medical history included hypertension, for which he used an angiotensin converting enzyme (ACE) inhibitor. Thrombolysis with recombinant tissue-type plasminogen activator (rtPA) was indicated. Three hours after intravenous injection of rtPA, the patient developed unilateral swelling of the tongue at the hemiparetic side (Fig. 1, left) and upper airway obstruction, which required nasotracheal intubation and admission to the Intensive Care Unit. One day after treatment with clemastine and adrenaline, the swelling had remarkably decreased. Repeated computed tomography confirmed cerebrovascular ischemia of the left hemisphere (Fig. 1, right).

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