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December 27, 2005; 65 (12) NeuroImages

Orolingual angioedema associated with ACE inhibitor use after rtPA treatment of acute stroke

Michael S. Rafii, Matthew Koenig, Wendy C. Ziai
First published December 27, 2005, DOI: https://doi.org/10.1212/01.wnl.0000190262.59672.4c
Michael S. Rafii
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Matthew Koenig
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Wendy C. Ziai
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Orolingual angioedema associated with ACE inhibitor use after rtPA treatment of acute stroke
Michael S. Rafii, Matthew Koenig, Wendy C. Ziai
Neurology Dec 2005, 65 (12) 1906; DOI: 10.1212/01.wnl.0000190262.59672.4c

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Angioedema occurs in up to 5% of patients on angiotensin-converting enzyme inhibitor (ACEI) therapy receiving IV rtPA.1 A 58-year-old man taking the combination ACEI amlodipine/benazepril received IV rtPA for clinical left middle cerebral artery territory acute infarction, NIHSS 9. Head CT was unremarkable. He developed orolingual angioedema 5 minutes after rtPA infusion was completed (figure). There was no airway compromise or hemodynamic instability to suggest anaphylactic reaction. Symptoms were treated with dexamethasone and a histamine antagonist. The angioedema resolved completely over the next 48 hours, as did his neurologic deficits.

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Figure. This patient developed severe orolingual angioedema involving predominantly the lower lip with apparent bilateral onset within 5 minutes of completing rtPA infusion. Erythrocyte sedimentation rate, immunoglobulin E, and complete cell count with differential were unremarkable.

1. Hill MD, Lye T, Moss H, et al. Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke. Neurology 2003;60:1525–1527.OpenUrlAbstract/FREE Full Text

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