Finestone H M, Fisher J, Greene-Finestone L S, Teasell R W, Craig I D
Department of Physical Medicine and Rehabilitation, London Health Sciences Centre, Ontario, Canada.
Am J Phys Med Rehabil. 1998 Nov-Dec;77(6):550-2. doi: 10.1097/00002060-199811000-00020.
The clinical events leading up to the sudden death of a dysphagic stroke patient 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 premorbid. The patient frequently coughed, and modified barium swallow testing showed dysphagia, with aspiration occurring only when consuming greater than teaspoon amounts of liquid. He subsequently died at home while eating a meal. Autopsy showed an intact large cheese ball (bocconcini) occluding the airway. Sudden death in the impulsive stroke patient secondary to airway occlusion by a food bolus has not previously been reported, although such patients seem to be at greater risk. New eating-related interventions are warranted for dysphagic patients who exhibit impulsivity. It is proposed that food particle size be limited to 1 cm2 and that such patients be closely monitored while eating.
描述了一名患有痴呆症的吞咽困难中风患者猝死前的临床事件。一名63岁男性发生了右侧丘脑和中脑梗死。在住院中风康复病房，他表现出明显的冲动行为和痴呆，后者被认为是病前就有的。患者频繁咳嗽，改良钡餐吞咽试验显示有吞咽困难，仅在摄入超过一茶匙量的液体时才会发生误吸。他随后在家中用餐时死亡。尸检显示一个完整的大奶酪球（小水牛芝士）堵塞了气道。尽管此类患者似乎风险更高，但此前尚未报道过因食物团块阻塞气道导致冲动性中风患者猝死的情况。对于表现出冲动行为的吞咽困难患者，有必要采取新的与进食相关的干预措施。建议将食物颗粒大小限制在1平方厘米，并在进食时密切监测此类患者。
