Good airway reflexes and normal sensorium do not assure safe tracheal extubation in patients with cerebral hemispheric pathology.

Following brain injury, return of consciousness and cough reflex are presumed to be associated with safe airway. We describe two patients who had a normal cough reflex, but impaired swallowing, which led to prolonged hospital stay. This report highlights the dissociation between the cough reflex and swallowing function in such patients.