Correia Ana Sofia, Matias Gonçalo, Calado Sofia, Lourenço Ana, Viana-Baptista Miguel
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.
Stroke Unit, Hospital S. Francisco Xavier (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal; Neurology Department, Hospital Egas Moniz (Centro Hospitalar Lisboa Ocidental), Lisbon, Portugal.
J Stroke Cerebrovasc Dis. 2015 Jan;24(1):31-40. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.045. Epub 2014 Nov 12.
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.
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.
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.
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.
口咽血管性水肿越来越被认为是阿替普酶治疗卒中的一种潜在危及生命的并发症。血管紧张素转换酶抑制剂（ACEi）的同时使用以及梗死灶位于大脑中动脉供血区似乎与这种并发症的较高风险相关。
我们报告了在我们卒中单元接受阿替普酶治疗的患者中发生口咽血管性水肿的病例。此外，我们回顾了文献以评估其病理生理学、临床特征和治疗选择。
在我们的卒中单元，236例接受阿替普酶治疗急性卒中的患者中，8例（3.4%）发生了血管性水肿。临床表现从局限性唇部水肿到伴有呼吸窘迫的广泛性舌部水肿不等，但所有病例经对症治疗后均逐渐消退。7例患者发生半球性卒中（4例血管性水肿位于缺血灶对侧，呈单侧性），而另1例患者发生右小脑上动脉卒中（血管性水肿位于缺血灶同侧，呈单侧性）。入院时美国国立卫生研究院卒中量表评分范围为6至24分（中位数为12.5分）。5例患者正在服用ACEi。我们的结果与先前发表的数据相似。在文献中，似乎接受阿替普酶治疗的所有卒中患者中口咽血管性水肿的发生率为0.2%至5.1%。
口咽血管性水肿是一种潜在并发症，卒中单元的治疗医生需要对此有所认识，即使在那些没有ACEi治疗史且梗死灶不在大脑中动脉供血区的病例中。所有接受阿替普酶治疗的患者都应进行仔细监测。
