Cardiovascular Instability Preceded by Orolingual Angioedema after Alteplase Treatment

An 87-year-old man taking antihypertensive medications, including 10 mg enalapril, daily visited our hospital complaining of motor aphasia, dysarthria, and right hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the left frontal lobe including the insular cortex and severe steno...

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Bibliographic Details
Published in:Internal Medicine 2016, Vol.55(4), pp.409-412
Main Authors: Kageyama, Takashi, Okanoue, Yusuke, Takai, Rieko, Suenaga, Toshihiko
Format: Article
Language:English
Subjects:
Aged, 80 and over
alteplase
Angioedema - chemically induced
Angioedema - pathology
Anti-Inflammatory Agents - therapeutic use
Antihypertensive Agents - therapeutic use
Aphasia, Broca - etiology
bradykinin
Cerebral Cortex - pathology
cerebral infarction
Disease Progression
Dysarthria - etiology
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - adverse effects
Frontal Lobe - pathology
Humans
Hydrocortisone - therapeutic use
Magnetic Resonance Imaging
Male
Mouth - pathology
orolingual angioedema
Paresis - etiology
rt-PA
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - adverse effects
Tongue - pathology
Treatment Outcome
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Summary:An 87-year-old man taking antihypertensive medications, including 10 mg enalapril, daily visited our hospital complaining of motor aphasia, dysarthria, and right hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the left frontal lobe including the insular cortex and severe stenosis of the left middle cerebral artery. After he received intravenous alteplase infusion, he developed orolingual angioedema followed by transient bradycardia with subsequent hypotension, resulting in the deterioration of his neurological signs and expansion of the ischemic lesion. Orolingual angioedema after intravenous alteplase infusion may follow cardiovascular instability and disease progression in stroke patients.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.55.4772