Cardiovascular instability preceded by orolingual angioedema after alteplase treatment

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Abstract

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.

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Kageyama, T., Okanoue, Y., Takai, R., & Suenaga, T. (2016). Cardiovascular instability preceded by orolingual angioedema after alteplase treatment. Internal Medicine, 55(4), 409–412. https://doi.org/10.2169/internalmedicine.55.4772

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