A 78-year old man presented with left hemiparesis of 90 minutes duration. A diagnosis of right MCA territory infarct was made and he was started on tissue plasminogen activator infusion for thrombolysis. 54 minutes after starting infusion, he developed swelling involving left side of tongue. t-PA infusion was stopped. A diagnosis of oro-lingual edema was made. Oro-lingual edema is a known adverse effect of t-PA.
Salient features of oro-lingual edema due to tissue plasminogen activator
- The swelling can be asymmetric at onset, and it commonly develops contralateral to the ischemic side of brain,
- It is more common with infarcts in insula region,
- It is more common in patients who have received treatment with ACE inhibitors.
- Treatment involves intravenous antihistamine and glucocorticoids.
Source: NEJM, June 18, 2020