Sudden death in the dysphagic stroke patient - A case of airway obstruction caused by a food bolus - A brief report

The clinical events leading up to the sudden death of a dysphagic stroke pa tient with dementia is described. A 63-yr-old man sustained right thalamic and mid-brain infarctions. On the inpatient stroke rehabilitation ward, he exhibited significant impulsivity and dementia, the latter felt to be premo rbid. The patient frequently coughed, and modified barium swallow testing s howed dysphagia, with aspiration occurring only when consuming greater than teaspoon amounts of liquid, He subsequently died at home while eating a me al. Autopsy showed an intact large cheese ball (bocconcini) occluding the a irway. Sudden death in the impulsive stroke patient secondary to airway occ lusion by a food bolus has not previously been reported, although such pati ents seem to be at greater risk. New eating-related interventions are warra nted for dysphagic patients who exhibit impulsivity. It is proposed that fo od particle size be limited to 1 cm(2) and that such patients be closely mo nitored while eating.