ABSTRACT
Background and aims: orolingual angioedema is a rare, but potentially life-threatening complication of recombinant tissue plasminogen activator (rtPA) administered in acute ischemic strokes. Some of the patients present contralateral swelling, referred as “on the opposite side of the hemiparesis”. It appears that patients treated previously with ACE-Inhibitors may be at an increased risk of developing angioedema after rtPA administration. Methods: The aim is to present the case of a rare and major complication of Alteplase administration in a patient treated with Enalapril iv before the initiation of the thrombolysis. Results: Case report: an eight years old right handed female presented in the Emergency Department with acute ischemic stroke, with one hour onset. The NIHSS scale was 11 points. In order to proceed with the administration, because of the high blood pressure, an iv Enalapril was administrated. 10 minutes after the thrombolytic therapy ended, the patient presented right hemi-orolingual edema, the swallowing being noticed by the medical staff and not as a complaint from the patient. In the absence of airway obstruction, medical treatment was performed and the patient was closely observed. Conclusion: the incidence of angioedema secondary to Alteplase administration increases with the use of ACE-I. In the Covid-19 Pandemic period, it is important to anticipate any possible complications, when patients are wearing a facial mask, in order to act promptly.