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Thyroid Hemorrhage Causing Airway Obstruction After Intravenous Thrombolysis for Acute Ischemic Stroke

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Abstract

Background

There are several life-threatening complications associated with intravenous thrombolysis after acute ischemic stroke such as symptomatic intracerebral hemorrhage, orolingual angioedema, or less frequent, bleedings of the mucosa or ecchymosis. Aside from these known critical incidents, rare and unfamiliar complications may be even more challenging, as they are unexpected and may mimic events that appear more frequently. We report a rare and unusual acute complication of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) (0.9 mg/kg) administered for acute ischemic stroke.

Methods

Medical records, radiologic imaging, and pathologic specimens were reviewed.

Results

A 86-year-old woman developed acute respiratory failure 20 h after thrombolysis with suspected angioedema triggered by intravenous rt-PA. The inspiratory stridor and dyspnea were unresponsive to bronchodilators, corticosteroids, and inhaled adrenaline. After endotracheal intubation, laryngoscopy showed no significant supraglottic narrowing. Thyroidal sonography and cervical computed tomography revealed a thyroidal mass causing a tracheal and vascular compression compatible with thyroidal hemorrhage. Sonography showed a nodular goiter of the right thyroid gland. A total thyroidectomy was performed and histologic analysis confirmed a hemorrhage of the right thyroidal lobe.

Conclusions

Acute airway obstruction with respiratory failure due to thyroidal hemorrhage after intravenous thrombolysis is an important life-threatening complication, mimicking an anaphylactic reaction or a more frequent orolingual angioedema.

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Acknowledgments

Dr. Raoul Sutter is supported by the Research Funds of the University of Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation.

Conflict of interest

Dr. Raoul Sutter, Dr. Gianmarco M. Balestra, Dr. Elisabeth Bruder, and Dr. Mandy Weissenburg have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Raoul Sutter, Mandy Weissenburg & Gianmarco M. Balestra

  2. Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Raoul Sutter

  3. Institute for Pathology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Elisabeth Bruder

Authors
  1. Raoul Sutter
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  2. Elisabeth Bruder
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  3. Mandy Weissenburg
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  4. Gianmarco M. Balestra
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Corresponding author

Correspondence to Gianmarco M. Balestra.

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Sutter, R., Bruder, E., Weissenburg, M. et al. Thyroid Hemorrhage Causing Airway Obstruction After Intravenous Thrombolysis for Acute Ischemic Stroke. Neurocrit Care 19, 381–384 (2013). https://doi.org/10.1007/s12028-013-9889-z

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  • DOI: https://doi.org/10.1007/s12028-013-9889-z

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