Persistent, severe post-thrombolysis angioedema: Simple management of a difficult problem

Foreman, Andrew; He, Tara; Chan, Yvonne; Gilbert, Ralph W.; Gullane, Patrick

doi:10.1016/j.amjoto.2015.05.004

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…In line with previous reports, when asymmetric, AE was contralateral to the ischemic hemisphere [24,25]. The reasons of this preferred localization are unclear.…”

Section: Discussionsupporting

confidence: 88%

Angioedema associated with thrombolysis for ischemic stroke: analysis of a case‐control study

et al. 2019

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Background Bradykinin‐mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. Objectives To clarify risk factors associated with bradykinin‐mediated AE after thrombolysis for acute ischemic stroke. Methods In a case‐control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin‐mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema. Results Fifty‐three thrombolysis‐related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin‐mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin‐converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ICU; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis‐related AE were female sex [odds ratio (OR), 3.04; 95% confident interval (CI), 1.32–7.01; P = 0.009] and treatment with angiotensin‐converting enzyme inhibitors [(OR), 6.08; 95% (CI), 2.17–17.07; P < 0.001]. Conclusions This case‐control study points out angiotensin‐converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.

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“…In line with previous reports, when asymmetric, AE was contralateral to the ischemic hemisphere [24,25]. The reasons of this preferred localization are unclear.…”

Section: Discussionsupporting

confidence: 88%

Angioedema associated with thrombolysis for ischemic stroke: analysis of a case‐control study

et al. 2019

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“…In that case, extrinsic compression of the tongue by the teeth was suspected to be the primary factor in the persistence of edema. The patient was noted to tolerate bite blocks well and resolution of the edema was noted within a few days with no long-term morbidity [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Persistent cases can present significant management difficulties. Several management strategies have been described including utilization of reduction glossectomy [ 2 , 4 – 6 , 8 , 9 ]. We present a rare case of severe lingual angioedema attributed to acquired C1 esterase inhibitor deficiency in the setting of systemic lupus erythematosus (SLE) which persisted despite utilization of previously described treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Persistent Acute Onset Macroglossia Treated with Compression Therapy

Johnson

Brown

Puscas

2017

Case Reports in Otolaryngology

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Acute macroglossia, while rare and often limited in duration, can present significant management challenges. The anatomic position of the tongue, which can result in airway compromise in cases of enlargement, contributes significantly to difficulty with management. We review several management options for persistent acute onset lingual macroglossia and present a novel noninvasive management technique in a case which was refractory to several strategies.

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“…In some cases, the extent of lingual oedema will not permit manual reduction. Foreman et al 9 used bite blocks placed under anaesthesia. The persistent oedema in this case was believed to be secondary to extrinsic compression of the tongue by the teeth.…”

Section: Discussionmentioning

confidence: 99%