Poster 333: Angiotensin-Converting Enzyme–Induced Angioedema in a Woman With a History of Ischemic Strokes: A Case Report

Abstract

Setting: Tertiary care hospital. Patient: A 53-year-old woman with history of left frontal ischemic strokes. Case Description: The patient developed right occipital headache on awakening with numbness, tenderness, edema, and tingling involving the left hand, with possible new left-sided weakness. Noncontrast head computed tomography revealed chronic left frontal and parasagittal hypodensity with adjacent prominent sulci and chronic basal ganglia ischemic infarctions. She was subsequently admitted to the neurology unit to undergo evaluation for stroke. She had been placed on an angiotensin-converting enzyme (ACE) inhibitor in the recent past, secondary to uncontrolled hypertension. Assessment/Results: Magnetic resonance imaging of the brain did not show evidence of an acute infarction but there was left frontal encephalomalacia from previous strokes. On exam there was evidence of left hand palmar erythema, numbness, and tingling. Left hand radiographs were normal except for the presence of soft tissue edema. She was diagnosed with angioedema likely caused by the recent addition of the ACE inhibitor. Her symptoms resolved with discontinuation of the ACE inhibitor. She was admitted to acute rehabilitation and was discharged home at her previous functional mobility. Discussion: This is a case of a patient with a history of strokes since 34 years of age, with a presentation that could be consistent with a neurologic or neuropathic disorder. Given her history, it was determined that she should be ruled out for such a process. The incidence of angioedema secondary to ACE inhibitors is rare and is reported in the literature to occur in about 0.1% to 0.2% of the general patient population. Conclusions: This case demonstrates how the clinical symptoms of angioedema in a patient with multiple neurologic risk factors for stroke can mimic certain symptoms of a neurologic or neuropathic disorder.