naa a22 4500 510799469 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9889-z doi (NATIONALLICENCE)springer-10.1007/s12028-013-9889-z Thyroid Hemorrhage Causing Airway Obstruction After Intravenous Thrombolysis for Acute Ischemic Stroke [Elektronische Daten] [Raoul Sutter, Elisabeth Bruder, Mandy Weissenburg, Gianmarco Balestra] Background: There are several life-threatening complications associated with intravenous thrombolysis after acute ischemic stroke such as symptomatic intracerebral hemorrhage, orolingual angioedema, or less frequent, bleedings of the mucosa or ecchymosis. Aside from these known critical incidents, rare and unfamiliar complications may be even more challenging, as they are unexpected and may mimic events that appear more frequently. We report a rare and unusual acute complication of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) (0.9mg/kg) administered for acute ischemic stroke. Methods: Medical records, radiologic imaging, and pathologic specimens were reviewed. Results: A 86-year-old woman developed acute respiratory failure 20h after thrombolysis with suspected angioedema triggered by intravenous rt-PA. The inspiratory stridor and dyspnea were unresponsive to bronchodilators, corticosteroids, and inhaled adrenaline. After endotracheal intubation, laryngoscopy showed no significant supraglottic narrowing. Thyroidal sonography and cervical computed tomography revealed a thyroidal mass causing a tracheal and vascular compression compatible with thyroidal hemorrhage. Sonography showed a nodular goiter of the right thyroid gland. A total thyroidectomy was performed and histologic analysis confirmed a hemorrhage of the right thyroidal lobe. Conclusions: Acute airway obstruction with respiratory failure due to thyroidal hemorrhage after intravenous thrombolysis is an important life-threatening complication, mimicking an anaphylactic reaction or a more frequent orolingual angioedema. Springer Science+Business Media New York, 2013 Acute ischemic stroke nationallicence Intravenous thrombolysis nationallicence Complication nationallicence Intubation nationallicence Airway obstruction nationallicence Neurocritical care nationallicence Sutter Raoul Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut Bruder Elisabeth Institute for Pathology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut Weissenburg Mandy Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut Balestra Gianmarco Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 381-384 1541-6933 19:3<381 2013 19 12028 https://doi.org/10.1007/s12028-013-9889-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9889-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sutter Raoul Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut NATIONALLICENCE 700 1- Bruder Elisabeth Institute for Pathology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut NATIONALLICENCE 700 1- Weissenburg Mandy Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut NATIONALLICENCE 700 1- Balestra Gianmarco Clinic of Intensive Care Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 381-384 1541-6933 19:3<381 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer