Recurrent macroglossia requiring tracheostomy after haemorrhagic basal ganglia stroke

A 50-year-old African American woman with hypertension, congestive heart failure, chronic kidney disease and prior cerebral vascular accident was transferred from an outside hospital after being found unresponsive and subsequently intubated for severe orolingual swelling. Imaging showed left thalami...

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Veröffentlicht in:BMJ case reports 2021-01, Vol.14 (1), p.e238775
Hauptverfasser: Osoba, Muyinat Y, Schneider, Alexander L, Alexiev, Borislav, Matsuoka, Akihiro J
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Schneider, Alexander L
Alexiev, Borislav
Matsuoka, Akihiro J
description A 50-year-old African American woman with hypertension, congestive heart failure, chronic kidney disease and prior cerebral vascular accident was transferred from an outside hospital after being found unresponsive and subsequently intubated for severe orolingual swelling. Imaging showed left thalamic haemorrhagic stroke, and the lingual swelling was clinically concerning for angio-oedema, with which a lingual biopsy was consistent. Work-up was negative for hereditary or acquired angio-oedema, and imaging was negative for structural causes. Of note, the patient had an episode of severe orolingual swelling 3 months prior to this presentation after suffering left thalamic haemorrhage which self-resolved after approximately 2 months. In both episodes lingual swelling predated receipt of tissue plasminogen activator and she had discontinued ACE inhibitor therapy since her first episode of tongue swelling. Despite medical and supportive management, tongue swelling progressed during admission and the decision was made to allow the patient’s tongue swelling to self-resolve.
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Imaging showed left thalamic haemorrhagic stroke, and the lingual swelling was clinically concerning for angio-oedema, with which a lingual biopsy was consistent. Work-up was negative for hereditary or acquired angio-oedema, and imaging was negative for structural causes. Of note, the patient had an episode of severe orolingual swelling 3 months prior to this presentation after suffering left thalamic haemorrhage which self-resolved after approximately 2 months. In both episodes lingual swelling predated receipt of tissue plasminogen activator and she had discontinued ACE inhibitor therapy since her first episode of tongue swelling. Despite medical and supportive management, tongue swelling progressed during admission and the decision was made to allow the patient’s tongue swelling to self-resolve.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2020-238775</identifier><identifier>PMID: 33431468</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Allergies ; Basal Ganglia Diseases - complications ; Basal Ganglia Diseases - diagnosis ; Basal Ganglia Diseases - therapy ; Case Report ; Case reports ; Consultants ; Dentistry ; Edema ; Etiology ; Female ; Hemorrhagic Stroke - complications ; Hemorrhagic Stroke - diagnosis ; Hemorrhagic Stroke - therapy ; Histamine ; Hospitals ; Humans ; Hypertension ; Kidney diseases ; Macroglossia - diagnostic imaging ; Macroglossia - etiology ; Macroglossia - therapy ; Middle Aged ; Musculoskeletal system ; Neutrophils ; Ostomy ; Otolaryngology ; Recurrence ; Stroke ; Thrombolytic drugs ; Tongue ; Tracheostomy ; Tracheotomy</subject><ispartof>BMJ case reports, 2021-01, Vol.14 (1), p.e238775</ispartof><rights>BMJ Publishing Group Limited 2020. 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Imaging showed left thalamic haemorrhagic stroke, and the lingual swelling was clinically concerning for angio-oedema, with which a lingual biopsy was consistent. Work-up was negative for hereditary or acquired angio-oedema, and imaging was negative for structural causes. Of note, the patient had an episode of severe orolingual swelling 3 months prior to this presentation after suffering left thalamic haemorrhage which self-resolved after approximately 2 months. In both episodes lingual swelling predated receipt of tissue plasminogen activator and she had discontinued ACE inhibitor therapy since her first episode of tongue swelling. Despite medical and supportive management, tongue swelling progressed during admission and the decision was made to allow the patient’s tongue swelling to self-resolve.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>33431468</pmid><doi>10.1136/bcr-2020-238775</doi><orcidid>https://orcid.org/0000-0003-1882-8511</orcidid><orcidid>https://orcid.org/0000-0001-9013-646X</orcidid><oa>free_for_read</oa></addata></record>
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subjects Allergies
Basal Ganglia Diseases - complications
Basal Ganglia Diseases - diagnosis
Basal Ganglia Diseases - therapy
Case Report
Case reports
Consultants
Dentistry
Edema
Etiology
Female
Hemorrhagic Stroke - complications
Hemorrhagic Stroke - diagnosis
Hemorrhagic Stroke - therapy
Histamine
Hospitals
Humans
Hypertension
Kidney diseases
Macroglossia - diagnostic imaging
Macroglossia - etiology
Macroglossia - therapy
Middle Aged
Musculoskeletal system
Neutrophils
Ostomy
Otolaryngology
Recurrence
Stroke
Thrombolytic drugs
Tongue
Tracheostomy
Tracheotomy
title Recurrent macroglossia requiring tracheostomy after haemorrhagic basal ganglia stroke
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