Orolingual Angioedema with Alteplase Administration for Treatment of Acute Ischemic Stroke

Abstract

A 68-year-old African-American male with a history of hypertension and gout (on lisinopril for approximately 1 year) presented to the Emergency Department with 2.5 h of left-arm weakness and numbness. Of note, the patient was in newly discovered rapid atrial fibrillation and, in light of persistent neurologic deficits (National Institutes of Health Stroke Scale 16→7) within 4.5 h, the decision was made to administer i.v. tissue plasminogen activator (tPA) for treatment of presumed embolic right middle cerebral artery stroke. Approximately 30 min post infusion, the patient developed severe diffuse orolingual angioedema of left hemilingual origin (Figure 1). There was no urticaria and no signs of anaphylaxis.