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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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. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b456t-86b6837e56deddc53fa4396dfc49fb01acd1e48c84a91f206821cb44247f3f303</citedby><cites>FETCH-LOGICAL-b456t-86b6837e56deddc53fa4396dfc49fb01acd1e48c84a91f206821cb44247f3f303</cites><orcidid>0000-0003-1882-8511 ; 0000-0001-9013-646X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802688/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802688/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33431468$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Osoba, Muyinat Y</creatorcontrib><creatorcontrib>Schneider, Alexander L</creatorcontrib><creatorcontrib>Alexiev, Borislav</creatorcontrib><creatorcontrib>Matsuoka, Akihiro J</creatorcontrib><title>Recurrent macroglossia requiring tracheostomy after haemorrhagic basal ganglia stroke</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><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.</description><subject>Allergies</subject><subject>Basal Ganglia Diseases - complications</subject><subject>Basal Ganglia Diseases - diagnosis</subject><subject>Basal Ganglia Diseases - therapy</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Consultants</subject><subject>Dentistry</subject><subject>Edema</subject><subject>Etiology</subject><subject>Female</subject><subject>Hemorrhagic Stroke - complications</subject><subject>Hemorrhagic Stroke - diagnosis</subject><subject>Hemorrhagic Stroke - therapy</subject><subject>Histamine</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Kidney diseases</subject><subject>Macroglossia - diagnostic imaging</subject><subject>Macroglossia - etiology</subject><subject>Macroglossia - therapy</subject><subject>Middle Aged</subject><subject>Musculoskeletal system</subject><subject>Neutrophils</subject><subject>Ostomy</subject><subject>Otolaryngology</subject><subject>Recurrence</subject><subject>Stroke</subject><subject>Thrombolytic drugs</subject><subject>Tongue</subject><subject>Tracheostomy</subject><subject>Tracheotomy</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkc1LHTEUxUNpqaKuuysDbkphNF-TZDaCSP0AQSgK7sKdTDJvXmcmejMj-N-bx7Oi3fRu7oX87klODiHfGD1iTKjjxmHJKaclF0br6hPZZbrSpa7p_ed38w45SGlNcwkmjRRfyY4QMs_K7JK7394tiH6aixEcxm6IKfVQoH9ceuynrpgR3MrHNMfxuYAweyxW4MeIuIKud0UDCYaig6kb8l6aMf7x--RLgCH5g9e-R-7Of92eXZbXNxdXZ6fXZSMrNZdGNcoI7SvV-rZ1lQggRa3a4GQdGsrAtcxL44yEmgVOleHMNVJyqYMIgoo9crLVfVia0bcu20AY7AP2I-CzjdDbjydTv7JdfLLaUK6MyQI_XgUwPi4-zXbsk_PDAJOPS7L5Js0Vl7XK6OE_6DouOGV7G0ppJZTRmTreUvkvU0If3h7DqN2kZnNqdpOa3aaWN76_9_DG_80oAz-3QDOu_6v2Apb6okw</recordid><startdate>20210111</startdate><enddate>20210111</enddate><creator>Osoba, Muyinat Y</creator><creator>Schneider, Alexander L</creator><creator>Alexiev, Borislav</creator><creator>Matsuoka, Akihiro J</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1882-8511</orcidid><orcidid>https://orcid.org/0000-0001-9013-646X</orcidid></search><sort><creationdate>20210111</creationdate><title>Recurrent macroglossia requiring tracheostomy after haemorrhagic basal ganglia stroke</title><author>Osoba, Muyinat Y ; Schneider, Alexander L ; Alexiev, Borislav ; Matsuoka, Akihiro J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b456t-86b6837e56deddc53fa4396dfc49fb01acd1e48c84a91f206821cb44247f3f303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Allergies</topic><topic>Basal Ganglia Diseases - complications</topic><topic>Basal Ganglia Diseases - diagnosis</topic><topic>Basal Ganglia Diseases - therapy</topic><topic>Case Report</topic><topic>Case reports</topic><topic>Consultants</topic><topic>Dentistry</topic><topic>Edema</topic><topic>Etiology</topic><topic>Female</topic><topic>Hemorrhagic Stroke - complications</topic><topic>Hemorrhagic Stroke - diagnosis</topic><topic>Hemorrhagic Stroke - therapy</topic><topic>Histamine</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Kidney diseases</topic><topic>Macroglossia - diagnostic imaging</topic><topic>Macroglossia - etiology</topic><topic>Macroglossia - therapy</topic><topic>Middle Aged</topic><topic>Musculoskeletal system</topic><topic>Neutrophils</topic><topic>Ostomy</topic><topic>Otolaryngology</topic><topic>Recurrence</topic><topic>Stroke</topic><topic>Thrombolytic drugs</topic><topic>Tongue</topic><topic>Tracheostomy</topic><topic>Tracheotomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Osoba, Muyinat Y</creatorcontrib><creatorcontrib>Schneider, Alexander L</creatorcontrib><creatorcontrib>Alexiev, Borislav</creatorcontrib><creatorcontrib>Matsuoka, Akihiro J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Osoba, Muyinat Y</au><au>Schneider, Alexander L</au><au>Alexiev, Borislav</au><au>Matsuoka, Akihiro J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recurrent macroglossia requiring tracheostomy after haemorrhagic basal ganglia stroke</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2021-01-11</date><risdate>2021</risdate><volume>14</volume><issue>1</issue><spage>e238775</spage><pages>e238775-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>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.</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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