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Orolinguales Angioödem unter systemischer Thrombolyse mit rt-PA

Eine unterschätzte Nebenwirkung

Orolingual angioedema under systemic thrombolysis with rt-PA

An underestimated side effect

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Zusammenfassung

Hintergrund

Das orolinguale Angioödem (OA) ist eine bislang zu wenig beachtete, aber klinisch relevante Nebenwirkung der systemischen Thrombolyse mit dem rekombinanten Gewebeplasminogenaktivator rt-PA bei der akuten zerebralen Ischämie. Sie tritt bei etwa 2% aller Thrombolysepatienten auf, wobei ACE-Hemmer in der Vormedikation das Risiko steigern. Bei meist milder und unilateraler Beteiligung von Lippen und Zunge kann es bei Ausweitung auf den Oropharynx zu potenziell lebensgefährlichen Atemwegsobstruktionen kommen.

Material und Methoden

Die klinischen Daten aller 407 Thrombolysepatienten unserer Klinik im Zeitraum Januar 2006 bis Oktober 2008 wurden einer retrospektiven Analyse auf Symptome eines OA unterzogen.

Ergebnisse

Neun von 407 Patienten (2,2%) wiesen ein OA auf. Die typische klinische Manifestation wird anhand zweier Fallbeispiele aufgeführt und durch einen Überblick der bislang publizierten Fälle vervollständigt.

Schlussfolgerung

Neben einer prophylaktischen Kontrolle der Mundhöhle während und nach Thrombolyse bestehen als Therapieoptionen eine frühzeitige antihistaminerge Therapie sowie ggf. eine Schutzintubation.

Summary

Background

Orolingual angioedema (OA) is an unappreciated complication of acute stroke treatment with recombinant tissue plasminogen activator (rt-PA). It has been described in 2% of patients receiving thrombolysis, and it seems that patients taking angiotensin-converting enzyme inhibitors are especially at risk. Even though the presentation is generally unilateral and limited to lips and tongue, an extension of edema to the oropharynx may lead to life-threatening upper airway obstruction.

Material and methods

In a retrospective analysis of clinical data of 407 patients treated with systemic rt-PA thrombolysis between January 2006 and October 2008 in our department, we describe the occurrence and clinical presentation of OA.

Results

Nine of 407 patients (2.2%) showed clinical signs of OA. Typical presentations of OA are illustrated in case reports describing two of these patients and are completed by an overview of the current literature.

Discussion

Besides prophylactic inspection of the oral cavity during and after thrombolysis, therapeutic options in case of OA include early intravenous antihistaminergic therapy and protective intubation.

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Authors and Affiliations

  1. Neurologische Klinik und Poliklinik, Universitätsklinikum Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland

    C. Ottomeyer, C. Sick, M.G. Hennerici & K. Szabo

Authors
  1. C. Ottomeyer
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  2. C. Sick
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  3. M.G. Hennerici
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  4. K. Szabo
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Correspondence to C. Ottomeyer.

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Ottomeyer, C., Sick, C., Hennerici, M. et al. Orolinguales Angioödem unter systemischer Thrombolyse mit rt-PA. Nervenarzt 80, 459–463 (2009). https://doi.org/10.1007/s00115-009-2685-5

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  • DOI: https://doi.org/10.1007/s00115-009-2685-5

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