Spontaneous lingual haematoma secondary to thrombolysis

A 71 year old man developed difficulty speaking and swallowing approximately three hours after he was treated with intravenous alteplase (10 mg bolus followed by 90 mg infusion over two hours) and dalteparin for pulmonary emboli causing haemodynamic instability. Haemorrhagic events are usually limited to the site of injection, although, clinicians should be aware that bleeding can occur at distant sites spontaneously or following minor trauma.