Isolated tongue angioedema after alteplase infusion in acute ischemic stroke

Background: Angioedema, like anaphylaxis, has been reported as a rare adverse event of alteplase infusion in acute ischemic stroke. Objective: We report the case of a patient with acute ischemic stroke who after treatment of alteplase developed angioedema. Methods: We report the case of an 81-year-old woman who presented to our observation with acute ischemic stroke. The patient was on therapy with 100 mg acetylsalicylic acid and a triple combination antihypertensive drug (perindopril 10 mg + 2.5 mg indapamide + 5 mg amlodipine). The patient was treated with alteplase infusion. Results: Five minutes after the end of the alteplase infusion (0.9 mg/kg for 1 hour) the patient developed isolated angioedema of the lips and tongue. Conclusion: Although the incidence of alteplase-induced angiodema in these patients is rare, this case report suggests the need for routine inspection of the tongue in acute ischemic patient in treatment with alteplase infusion, especially in female patients in treatment with ACE inhibitors.

Seni Mendeteksi Penyakit Melalui Lidah Dalam Budaya Pengobatan Tradisional Tiongkok

<p><em>Traditional medicine is closely related to the culture in which it develops. The art of detecting disease through the tongue is one of the main diagnostic methods in Traditional Chinese Medicine culture that has been applied since the classical times of the Yellow Emperor. Tongue diagnosis in Traditional Chinese Medicine culture is a method for diagnosing disease and disease patterns by visual inspection of the tongue and its various features. As with other diagnostic methods, the diagnosis of the tongue is based on the principle that the outside of the body reflects the inside of the body. The tongue provides important clues that reflect the condition of the internal organs in each patient. In Traditional Chinese Medicine culture, the external structure of the body often reflects the condition of the inner structure and can give an important indication of internal disharmony.</em></p>

Tongue Signs

The tongue is heavily innervated and plays a central role in articulation, swallowing, and tasting. Unilateral weakness is usually well tolerated. Intermittent weakness of the tongue is highly indicative of myasthenia gravis (MG), while progressive weakness and atrophy is typical for amyotrophic lateral sclerosis (ALS). Tongue weakness without atrophy or fasciculations is a sign of upper motor neuron (UMN) or cerebellar involvement. Lingual dysarthria should be differentiated from other types of dysarthria. Tongue tremor is common and may be confused with fasciculation. Inspection of the tongue while resting in the mouth is more telling than a contracted and protruded tongue for the presence of fsciculations. Direct needle examination of the tongue is painful and is rarely needed.

Tongue Signs

The tongue is heavily innervated and plays a central role in articulation, swallowing, and tasting. Unilateral weakness is usually well tolerated. Intermittent weakness of the tongue is highly suspicious of myasthenia gravis, while progressive weakness and atrophy are typical for amyotrophic lateral sclerosis(ALS). Tongue weakness without atrophy or fasciculations is a sign of upper motor neuron or cerebellar involvement. Lingual dysarthria should be differentiated from other types of dysarthria. Tongue tremor is common and may be confused with fasciculations. Inspection of the tongue is often diagnostically useful in neuromuscular patients. Fasciculations, myokymia, grooving with pressure, and trigrooved tongue are examples.

Cysticercosis in experimentally and naturally infected pigs: parasitological and immunological diagnosis

Our objective was to evaluate the diagnosis of swine cysticercosis by examining "ante mortem" (inspection of the tongue), "post mortem" (inspection and detailed necropsy) and ELISA for research in serum of antibodies (Ab-ELISA) and antigens (Ag-ELISA). Seven (7) pigs were experimentally infected orally with eggs of Taenia solium and another 10 were naturally infected. In the pigs experimentally infected, inspection of the tongue was negative in all animals, in the routine inspection detailed necropsy and cysticercis were identified in all of them. In pigs with heavy natural infection, inspection of the tongue identified cysticerci in two (20%), while at inspection with necropsy the parasites were identified in large quantities in all animals. In ELISA for antibody search (Ab-ELISA) TS-14 recombinant protein was used, and in search for antigen (Ag-ELISA) a monoclonal antibody against this protein. In animals experimentally infected, blood was collected weekly for 140 days. The Ab-ELISA identified an increase in titers of antibody to cysticerci 21 days after infection, and at the end of the experimental period six animals (86%) were positive to the test. The search for circulating antigens (Ag-ELISA) was positive in two pigs 28 to 91 days after infection. All naturally infected pigs were positive for Ag-ELISA and Ab-ELISA. The search for antibodies and antigens by ELISA in serum from 30 pigs of a local farm and without history of cysticercosis was negative. Thus, the use of TS-14 antigen in ELISA test (Ab-ELISA) can be useful for the diagnosis of cysticercosis in pigs with low infection.

Mysteries of the Tongue

Tongue Diagnosis is a diagnostic tool that is so important and pervasive in contemporary training and practice that it is usually considered and presented as if it had always been so. Diagrammatic and theoretical detail in Chinese medical textbooks give the impression that, as a system, tongue diagnosis has achieved a parity with pulse reading as a cornerstone of the contemporary clinical encounter. And yet, even a cursory look at a selection of classical texts, case histories and formularies from the Han to the Ming dynasty suggests that tongue diagnosis has not always enjoyed its current status. While the tongue is mentioned as an indicator of health or illness in classical texts, the privileging of the tongue in diagnosis is relatively recent. This article presents a preliminary survey of tongue diagnosis in Chinese medicine and offers some hypotheses about the process through which inspection of the tongue transformed from incidental observations to become a pillar of diagnosis. At the same time it is a practitioner̓s account and stands as a personal reflection on the value and relevance of engaging in history for practitioners of traditional medicines.