title: Orolingual angiodema associated with alteplase treatment of acute stroke: a reappraisal.
abstract: BACKGROUND
  Orolingual angioedema has been increasingly recognized as a potentially life-threatening complication associated with alteplase treatment of stroke. Concomitant treatment with an angiotension converting enzyme inhibitor (ACEi) and localization of infarction in the territory of middle cerebral artery seem to be associated with a higher risk of this complication.
  
  
  METHODS
  We report the cases of orolingual angioedema among the patients undergoing alteplase treatment in our Stroke Unit. Additionally, we reviewed the literature to evaluate the pathophysiology, clinical characteristics, and treatment options.
  
  
  RESULTS
  In our Stroke Unit, among 236 patients given alteplase for acute stroke, 8 patients (3.4%) developed angioedema. The clinical picture varied from localized labial edema to extensive lingual edema with respiratory distress but in all cases it gradually resolved with symptomatic treatment. Seven patients had a hemispheric stroke (4 with lateralized angioedema, contralateral to the ischemic lesion), whereas the other 1 patient had a right superior cerebellar artery stroke (with lateralized angioedema, ipsilateral to the ischemic lesion). The National Institutes of Health Stroke Scale score at admission ranged from 6 to 24 (median 12.5). Five patients were taking an ACEi. Our results are similar to previously published data. In the literature, it appears that orolingual angioedema occurs in .2-5.1% of all stroke patients receiving Alteplase treatment.
  
  
  CONCLUSIONS
  Orolingual angioedema is a potential complication of which treating physicians in stroke units need to be aware, even in those cases without history of ACEi treatment and without infarction in the territory of the middle cerebral artery. All patients who receive alteplase treatment should be monitored carefully.
authors.affiliation: Stroke Unit, Hospital S. Francisco Xavier (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; Neurology Department, Hospital Egas Moniz (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Ana Sofia
authors.initials: AS
authors.lastname: Correia
authors.affiliation: Stroke Unit, Hospital S. Francisco Xavier (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; Neurology Department, Hospital Egas Moniz (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal.
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Matias
authors.affiliation: Stroke Unit, Hospital S. Francisco Xavier (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; Neurology Department, Hospital Egas Moniz (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Calado
authors.affiliation: Stroke Unit, Hospital S. Francisco Xavier (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; Internal Medicine Department, Hospital S. Francisco Xavier (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Lourenço
authors.affiliation: Stroke Unit, Hospital S. Francisco Xavier (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; Neurology Department, Hospital Egas Moniz (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. Electronic address: mvianabaptista@fcm.unl.pt.
authors.forename: Miguel
authors.initials: M
authors.lastname: Viana-Baptista
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced* / Q000473:pathology; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology*; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D014059:Tongue / Q000473:pathology*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Alteplase; anaphylactoid; angioedema; rt-PA; thrombolysis