Incidence of orolingual angioedema after intravenous thrombolysis for stroke.

INTRODUCTION: Orolingual angioedema (OA) is a known adverse effect of intravenous (i.v.) alteplase. We analyzed all patients treated with i.v. alteplase for stroke at our hospital since approval of i.v. thrombolysis in Italy in 2004 to assess the incidence of this complication. PATIENTS AND RESULTS: Four hundred thirty-three patients received alteplase for stroke from April 2004 to May 2017. Two women developed OA (0.4%; 95% confidence interval 0.1 to 1.6%). Angioedema was mild in one case and severe in the other, with massive swelling of the lips, tongue, and oropharyngeal mucosa, and oropharyngeal bleeding, requiring intubation. Neither patient used ACE-inhibitors. DISCUSSION: The incidence of orolingual angioedema was very low in our series. Although OA is usually mild, anaphylactoid reactions may rarely occur, because of the variable degree of activation of the complement system and kinin cascade caused by alteplase. In such instances, admission to neurointensive care may be required. Specific bradykinin antagonists or drugs that target the kallikrein-kinin system are beginning to be used in the more severe cases. Thus, doctors and nurses caring for acute stroke patients need to be able to recognize and treat this complication.

Stimulus- and frequency-specific oscillatory mass responses to visual stimulation in man.

Oscillatory mass responses centered at about 20-35 Hz or 100-120 Hz occur (after contrast or luminance visual stimulation, respectively) in the retina and cortex of animals and man and are recorded by electrical or magnetic methods. These oscillatory events reflect stimulus-related uni/multicellular oscillations of the firing rate/membrane potential and result from synchronization of neuronal assemblies selectively responding to the stimulus characteristics. Methodological problems in the study of these events derive from the contiguity in frequency between the ERG or VEP and the oscillatory responses and from the need to reliably define oscillatory events in time and frequency. Two methods (time-frequency analysis by matching pursuit and locking index) have been implemented to approach this issue. Theory and application are reviewed.