Aspiration pneumonia symptoms in a patient who had a recent stroke
As a practicing internal medicine physician working in the ICU, I take care of patients with aspiration pneumonia symptoms several times every week. Although aspiration pneumonia is recognized as a single disease, aspiration pneumonia symptoms depend upon the underlying cause and the unique circumstances of the patient. Here, I will describe aspiration pneumonia symptoms in a patient who had a recent stroke. All of my patient stories are based on real patients I took care of. I have been changing the names, professions and other details to protect the identities of those patients.
Mrs. N is a 76 year old female who was in the hospital recently. I had admitted her to the ICU just 15 days ago after the terrible incident. She had been a very active lady before that. She did have a heart condition but she had refused to let it slow her down. She was still going out for her daily 3 miles walks. She took her pills regularly and followed her doctor’s instructions. But unfortunately, she had the stroke anyways.
Those were the memories that came to my mind when the ER doctor called me and told me that Mrs. N is back in the hospital and has probably developed aspiration pneumonia symptoms. As the on call doctor, I went down and greeted her. Although she looked very weak and sick, she did have that unmistakably cheerful smile that I remembered from last time. Her speech was still a little slurry but she was able to talk as long as she spoke slowly. Her eyes cheered up as she remembered my face. “Oh, here you are again!” she said. She had told me she hoped to meet me again but not in the hospital. Unfortunately, she was back in the hospital in just about 10 days.
Her stroke had left her with a weakness on the left side which she was trying to fight with her therapist. She was gaining back some of her strength. Her physical therapist was very happy to see her improvement. While she had to push most of her other patients too hard to get them moving, she had to tell Mrs. N to slow down on multiple occasions for her safety. She was, as always, full of energy even when her left side was not moving.
One aspect of her recovery that was slightly lagging behind was her speech. She had been working with the speech therapist to try gain back the normal pattern of speech that she lost from her stroke. As speech and swallowing are very closely related tasks performed by the same group of muscles in the mouth and the throat, she also had trouble swallowing. She was very determined to gain back her control of speech and swallow. In the process, she might have slightly overdone herself. She kept practicing those exercises the speech therapist recommended and felt that she was almost back to normal, when ,in fact she, still had some significant deficits. She tried to swallow more than what the therapist recommended. The therapist was concerned that she might develop aspiration pneumonia symptoms if she continued to do that.
She told me she almost choked on her food 2 days ago and has been having a slight cough since then. She now felt weaker and did not have the courage to continue her daily exercise. The therapist was very surprised to hear this from her and immediately knew something was wrong with her. She had known her too well to believe that she was just too tired that they. She was then bought down to the ER and had some blood work and chest x-ray done. I looked at the x-ray; there was definitely an area of haziness on the right side which seemed to correlate with the middle lobe of the right lung.
The right middle lobe is the part of the lung that would most likely end up receiving anything you accidentally throw down your air pipe instead of the food pipe. The air pipe is right next to the food pipe in your neck and there is a mechanism by which the air pipe is closed every time you swallow something. But Mrs. N’s throat muscle was weakened by the stroke and it failed to close the air pipe when she was swallowing her food. The food then stayed in her lungs and became infected by attracting bacteria to grow in it. This is how the infection spreads and the patient develops aspiration pneumonia symptoms. As the infection worsened, it put her body under stress and made her feel very weak.
Her final diagnosis was aspiration pneumonia and she was treated with appropriate antibiotics. She stayed in the hospital for three days and then went home. To prevent further aspiration, the speech therapist repeated some swallow studies to see what kind of food seemed to be ones that she can easily swallow without aspirating. This time she promised not to push herself too hard.
You can read more about aspiration pneumonia symptoms in this article in The US National Library of Medicine. Here is an abstract to an article in PubMed describing the numbers of patients with stroke that developed aspiration pneumonia symptoms.
I hope that the story of my patient would provide you with a context and an example to understand more about aspiration pneumonia symptoms. Pneumonia is a very common disease but there are so many different things you can learn about the disease from actually taking care of the patients with pneumonia.
I will talk about several other aspects of pneumonia in my next few articles. Please do not forget to send me your questions or comments about this patient centered approach to teaching different aspects of pneumonia.
Related articles about pneumonia by Dr. Sapkota published in Yahoo: