A 5-year-old girl was found choking and breathless by her father. She slumped forward and experienced a short generalized convulsion. Her parents had noted noisy, irregular breathing at night beginning at age 18 months. This had been diagnosed by her general practitioner as mild asthma. On admission to the hospital, she was postictal and cyanotic, with costal retractions and crackles heard at both lung bases. A chest roentgenogram was obtained (Fig 1). A diagnosis of hypoxic convulsion associated with aspiration pneumonia was made. After 24 hours of assisted ventilation, she made a steady recovery, with resolution of the roentgenographic abnormalities.
One month later, a barium esophagogram was obtained to investigate the possible cause of aspiration (Fig 2). During the next 6 weeks, she complained of dizziness and became unsteady on her feet. Soon afterward, she again developed pneumonia and was admitted to the hospital. Results of neurologic examination revealed truncal