Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
Int J Mol Sci. 2023 Jul 29;24(15):12184. doi: 10.3390/ijms241512184.
Neurologic manifestations have been occasionally described in patients with bradykinin-mediated angioedema. The existing literature is currently limited to case series and case reports mainly described in the hereditary forms (HAE) concerning central nervous system (CNS) involvement. On the contrary, very little is known about peripheral and autonomic nervous system manifestations. CNS involvement in HAE may present with symptoms including severe headaches, visual disturbance, seizures, and various focal and generalized deficits. In addition, a stroke-like clinical picture may present in HAE patients. In turn, some drugs used in patients with cardiovascular and neurologic disorders, such as recombinant tissue plasminogen activator (r-tPA) and angiotensin-converting enzyme inhibitors (ACEI), may produce medication-induced angioedema, resulting in a diagnostic challenge. Finally, most patients with HAE have higher levels of psychological distress, anxiety, and depression. With this review, we aimed to provide an organized and detailed analysis of the existing literature on neurologic and psychiatric manifestations of HAE to shed light on these potentially invalidating symptoms and lay the foundation for further personalized diagnostic pathways for patients affected by this protean disease.
神经系统表现偶尔在缓激肽介导的血管性水肿患者中描述。目前的文献主要限于病例系列和病例报告，主要描述涉及中枢神经系统（CNS）受累的遗传性形式（HAE）。相反，关于周围和自主神经系统表现的知识非常有限。HAE 中的 CNS 受累可能表现为严重头痛、视力障碍、癫痫发作和各种局灶性和全身性缺陷。此外，HAE 患者可能会出现类似中风的临床症状。反过来，一些用于心血管和神经系统疾病患者的药物，如重组组织纤溶酶原激活剂（r-tPA）和血管紧张素转换酶抑制剂（ACEI），可能会产生药物引起的血管性水肿，从而带来诊断挑战。最后，大多数 HAE 患者的心理困扰、焦虑和抑郁水平较高。通过本次综述，我们旨在对 HAE 的神经和精神表现的现有文献进行系统和详细的分析，以阐明这些潜在的使人衰弱的症状，并为受这种多形性疾病影响的患者建立进一步的个性化诊断途径奠定基础。
