[Dysphagia] loss of consciousness while swallowing in SCI vent depend pt

[mcronen at comdis.umass.edu (mcronen@comdis.umass.edu)]

I have just received a consult for a swallowing evalution for a 74 yo C2-4 vent 
dependent gentleman with spinal cord injury who fell off roof in 1999. In the 
past month there have been several epidosdes of decreased level of ability to 
swallow. Wife reports the following: Patient is currently on a pureed diet 
which wife mixes herself. Patient will have a small amount of bolus of food in 
his mouth and after 3-4 spoonfuls, he has decreased ability to swallow, he then 
goes into a near trance with a decreased level of consciousness. There is no 
volunatry or involuntary choking at this time. After several hours , patient 
produces a whitish bubbly liquid from his mouth. He then sleeps deeply the 
remainder of the day. His body temp reduces that evening to around 90 or 91 
degrees. This has happened 3 times in the past month. 
Any ideas why this occurs. Any suggestions what to look for or ask about?
I don't know if this behavior is only triggered when eating. Any help would be 
appreciated.