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After intubation with airway suction of food debris, neuroimaging showed global cerebral hypoperfusion, early hypoxic-ischemic encephalopathy, and microhemorrhages. EEG demonstrated severe cerebral dysfunction, and later exam findings indicated poor prognosis. Prompt airway management and imaging/EEG support prognostication after choking-related 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1060  \nAvailable online [at](at www.sciencedirect.com)[ www.sciencedirect.com](at www.sciencedirect.com)  \njournal [homepage:](homepage: www.elsevier.com/locate/radcr)[ www.elsevier.com/locate/radcr](homepage: www.elsevier.com/locate/radcr)  \n| Case Report\u003Cbr>Choking leading to cardiac arrest and subsequent atypical radiological features of brain damage: A case report ✩\u003Cbr>Bano Alsaleh, MDa,1, Ahmed Alanzi, MDb,1,∗, Dawood Alatefi, MDc, Khaled M AlAani, MDd, Khalid Khan, MDe, Noora A Jamsheer, MDa, Aysegul Sarsilmaz, MDa\u003Cbr>a Radiology Department, King Hamad University Hospital, Building 2435, Road 2835, Block 228, Busaitin, Muharraq, Kingdom of Bahrain\u003Cbr>b Anaesthesia and Pain Management Department, King Hamad University Hospital, Building 2435, Road 2835, Block 228, Busaitin, Muharraq, Kingdom of Bahrain\u003Cbr>c The University of Jordan, Queen Rania Al-Abdullah Street, Amman 11942, Jordan\u003Cbr>d Arabian Gulf University, Salmaniya Medical complex, Manama 329, Kingdom of Bahrain\u003Cbr>e Department of Radiology, Salmaniya Medical Complex, Al Salmaniya Avenue, Manama 303, Kingdom of Bahrain |  |\n| --- | --- |\n| a r t i c l e i n f o | a b s t r a c t\u003Cbr>Choking-induced cardiac arrest leading to hypoxic brain injury is a rare and life-threatening event. We report the case of a 73-year-old man who collapsed while breaking his fast during Ramadan due to food aspiration. He was successfully resuscitated after prolonged cardiopulmonary resuscitation (CPR) . Upon admission, he was intubated, and a large amount of food debris was suctioned from his airway. Neuroimaging revealed global cerebral hypoperfusion, early hypoxic-ischemic encephalopathy, and microhemorrhages in the basal ganglia and temporal lobes, suggestive of reperfusion injury. Electroencephalography (EEG) indicated severe cerebral dysfunction. Despite supportive intensive care, neurological reassessment revealed fixed pupils and absent brainstem reflexes, indicating a poor prognosis. This case underscores the importance of prompt airway management and highlights the diagnostic role of imaging and neurophysiology in prognostication following chokingrelated cardiac arrest.\u003Cbr>© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington.\u003Cbr>This is an open access article under the CC BY-NC-ND license\u003Cbr>([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) |\n| Article history:\u003Cbr>Received 5 October 2025 Revised 13 November 2025 Accepted 18 November 2025 |  |\n| Keywords: Choking Cardiac arrest\u003Cbr>Magnetic resonance imaging (MRI) Susceptibility-weighted imaging (SWI)\u003Cbr>Computed tomography (CT) Neuroimaging |  |\n\n✩ Competing Interests: The authors have declared that no competing interests exist.  \n∗ Corresponding author.  \nE-mail [address:](address: Ahmedo-1995@hotmail.com)[ Ahmedo-1995@hotmail.com](address: Ahmedo-1995@hotmail.com) (A. Alanzi).  \n1 Co-first authors.  \n[https://doi.org/10.1016/j.radcr.2025.11.055](https://doi.org/10.1016/j.radcr.2025.11.055)  \n1930-0433/© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/))  \nIntroduction  \nChoking is a life-threatening emergency caused by upper airway obstruction that prevents normal airflow into the lungs and leads to acute hypoxemia a critical reduction in blood oxygen levels that compromises perfusion to vital organs [1] . The brain, being highly sensitive to oxygen deprivation, can sustain irreversible neuronal injury within minutes if oxygenation is not promptly restored [2] . When choking progresses to cardiac arrest, the resulting hypoxic-ischemic brain injury (HIBI) involves both primary and secondary mechanisms. The initial oxygen deprivation disrupts cellular metabolism and ATP production, while secondary processes","cbCainwpXjz5izol","https://ap.wps.com/l/cbCainwpXjz5izol","pdf",1517492,"English","# Introduction\n# Case presentation","[{\"question\":\"What event triggered the cardiac arrest in this case?\",\"answer\":\"The cardiac arrest was triggered by food aspiration while the patient was breaking his fast during Ramadan, leading to choking and acute hypoxemia.\"},{\"question\":\"What neuroimaging findings suggested brain injury?\",\"answer\":\"Imaging revealed global cerebral hypoperfusion, early hypoxic-ischemic encephalopathy, and microhemorrhages in the basal ganglia and temporal lobes, suggestive of reperfusion injury.\"},{\"question\":\"How did EEG influence the assessment of the patient’s condition?\",\"answer\":\"Electroencephalography indicated severe cerebral dysfunction, supporting the overall poor neurologic prognosis despite intensive supportive care.\"}]","Choking leading to cardiac arrest and subsequent atypical radiological features of brain damage - A case report | PDF",1790602316,15]