Inquest into the death of Ezekiel HOWARD

10y · Male·Unascertained - sudden and unexpected death; evidence did not allow determination between sudden unexpected death in epilepsy (SUDEP) and sudden cardiac death (SCD)

Ezekiel Howard, a 10-year-old boy, died suddenly in his sleep on 12 September 2011. His death remains unexplained despite extensive investigation. The coroner could not determine whether death resulted from undiagnosed epilepsy (SUDEP) or sudden cardiac death, as evidence was incomplete and inconclusive. The boy had episodes of transient neurological symptoms in April-May 2011 that prompted investigation including ECG, MRI, and echocardiogram, but no definitive diagnosis was established. An EEG was recommended but not completed before his death. Post-mortem examination revealed subtle cardiac inflammation and minor brain findings but no definitive cause. Critical learning: the importance of completing diagnostic workup in children with unexplained neurological episodes, the challenge of diagnosing focal epilepsy without specialist input and EEG, and the necessity of proper medical records management. A particularly concerning systemic failure involved deletion of his echocardiogram images by the hospital's ultrasound equipment system.