Question: What characterizes the orolingual angioedema associated with the administration of tissue plasminogen activator?
Answer: According to the cited reference, “orolingual angioedema is a rare adverse effect of tissue plasminogen activator (tPA) treatment of acute ischemic stroke with a reported incidence of between 1% and 5%. The frontal, insular, and peri-insular regions are often involved and are believed to play a role in the pathophysiology of stroke-associated angioedema…..Orolingual angioedema developing after tPA administration for acute ischemic stroke may manifest as unilateral swelling of the lips tongue and face. The resultant edema is commonly contralateral to the ischemic lesion that is believed to be due to the infarction’s triggering autonomic dysfunction and vasomotor changes in the hemiparetic side. Despite this distinct presentation, available literature has demonstrated equal representation of bilateral, contralateral and ipsilateral edema.” (Pahs L et al. A novel approach to the treatment of orolingual angioedema after tissue plasminogen activator administration. 2016 Ann Emerg Med 68(3):345-348)