LAUSR

Orolingual angioedema in acute ischemic stroke patients following IV recombinant tissue plasminogen activator (rtPA) treatment is a potentially life-threatening complication. It is estimated to occur in 1.7%–7.9% of all cases.1,2 This complication is considered to be anaphylactoid as opposed to true anaphylaxis.3 It is thought to be a product of increased levels of bradykinin and histamine mediated in part by IV rtPA and potentiated by other factors such as stroke location involving the insular cortex causing dysfunction of the autonomic system, concomitant medications such as angiotensin-converting enzyme inhibitors (ACEI), and personal predisposition.2,4 Treatment includes antihistamines, steroids, complement inhibitors, and airway protection.5 Comprehensive reviews on rtPA-related orolingual angioedema fail to describe previous occurrences as a risk factor for its development.2,4 Furthermore, this complication is not a formal contraindication to rtPA and we failed to find case reports on this issue. We suspect some acute ischemic stroke patients may be denied this treatment due to history of rtPA-related orolingual angioedema. We report such a case where a patient with previous rtPA-related orolingual angioedema was successfully treated with IV rtPA without adverse reactions.