Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Neurocrit Care. 2013 Dec;19(3):381-4. doi: 10.1007/s12028-013-9889-z.
There are several life-threatening complications associated with intravenous thrombolysis after acute ischemic stroke such as symptomatic intracerebral hemorrhage, orolingual angioedema, or less frequent, bleedings of the mucosa or ecchymosis. Aside from these known critical incidents, rare and unfamiliar complications may be even more challenging, as they are unexpected and may mimic events that appear more frequently. We report a rare and unusual acute complication of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) (0.9 mg/kg) administered for acute ischemic stroke.
Medical records, radiologic imaging, and pathologic specimens were reviewed.
A 86-year-old woman developed acute respiratory failure 20 h after thrombolysis with suspected angioedema triggered by intravenous rt-PA. The inspiratory stridor and dyspnea were unresponsive to bronchodilators, corticosteroids, and inhaled adrenaline. After endotracheal intubation, laryngoscopy showed no significant supraglottic narrowing. Thyroidal sonography and cervical computed tomography revealed a thyroidal mass causing a tracheal and vascular compression compatible with thyroidal hemorrhage. Sonography showed a nodular goiter of the right thyroid gland. A total thyroidectomy was performed and histologic analysis confirmed a hemorrhage of the right thyroidal lobe.
Acute airway obstruction with respiratory failure due to thyroidal hemorrhage after intravenous thrombolysis is an important life-threatening complication, mimicking an anaphylactic reaction or a more frequent orolingual angioedema.
急性缺血性脑卒中后静脉溶栓治疗会引起一些危及生命的并发症，如症状性颅内出血、口咽血管性水肿，或较少见的黏膜或瘀斑出血。除了这些已知的危急事件外，罕见且不常见的并发症可能更具挑战性，因为它们是意外发生的，可能与更常见的事件相似。我们报告了一例急性缺血性脑卒中患者静脉使用重组组织型纤溶酶原激活剂（rt-PA）（0.9mg/kg）溶栓治疗后罕见且不寻常的急性并发症。
回顾了病历、影像学检查和病理标本。
一名 86 岁女性在接受 rt-PA 静脉溶栓后 20 小时发生急性呼吸衰竭，疑似血管性水肿引起。吸气性喘鸣和呼吸困难对支气管扩张剂、皮质类固醇和吸入肾上腺素无反应。气管插管后，喉镜检查未见明显的声门上狭窄。甲状腺超声和颈椎 CT 显示甲状腺肿块导致气管和血管受压，符合甲状腺出血。超声显示右侧甲状腺有结节性甲状腺肿。行全甲状腺切除术，组织学分析证实右侧甲状腺叶出血。
静脉溶栓后甲状腺出血导致的急性气道阻塞和呼吸衰竭是一种重要的危及生命的并发症，类似于过敏反应或更常见的口咽血管性水肿。
