title: Onset of Orolingual Angioedema After Treatment of Acute Brain Ischemia with Alteplase Depends on the Site of Brain Ischemia: A Meta-analysis.
abstract: BACKGROUND
  Alteplase is used to treat acute ischemic stroke. However, it has several documented adverse effects, including the development of orolingual angioedema (OA). Although, OA is a rare side-effect, it is thought to be life-threatening and is difficult to treat. Until date, little is known about this condition and a better understanding of OA may contribute to improve the morbidity and mortality amongst patients that develop this condition.
  
  
  METHODS
  Using the PubMed and Medknow databases, we searched for peer reviewed published articles on OA after alteplase administration in 1950-2012. We gathered demographic data and investigated the relationship between the location of OA, neurological symptoms and the site of cerebral ischemia. In addition, we studied the effects of hypertensive premedication on OA development. We identified 19 published manuscripts that fulfilled our search criteria. These manuscripts reported 41 cases of OA after alteplase administration.
  
  
  RESULTS
  We found that this condition is associated with cerebral ischemia (P < 0.012) and that 65.9% (n = 27) of patients who developed OA had a hypertensive drug as a premedication.
  
  
  CONCLUSIONS
  Although OA is a rare side-effect of alteplase, it can occur depending upon the localization of acute cerebral ischemia.
authors.affiliation: Department of Internal Medicine, University Hospital of Saarland, Homburg, Saarland, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Yayan
keywords: Acute ischemic stroke; Angiotensin-converting enzyme inhibitors; Ischemic stroke; Life-threatening; Orolingual angioedema; Recombinant tissue plasminogen activator; Tongue swelling