Nasogastric Tube Syndrome in the Neurosurgical Intensive Care Unit: A Case Report

Abstract Nasogastric tube (NGT) syndrome is a rare but potentially life-threatening complication of prolonged NGT placement. We report a 39-year-old woman with drug-resistant epilepsy who underwent anterior temporal lobectomy with amygdalohippocampectomy. Postoperatively, she developed status epilepticus requiring mechanical ventilation and NGT insertion. On postoperative day 8, after removal of the endotracheal tube, the patient developed inspiratory stridor and hypoxia, which were initially managed medically. A second extubation attempt was later given, which also failed, necessitating tracheostomy. Flexible laryngoscopy revealed a midline NGT in the postcricoid space, bilateral arytenoid edema, fixed vocal cords, and a narrowed glottic space—findings diagnostic of NGT syndrome. The tube was promptly removed, and she was managed with corticosteroids, antibiotics, and proton pump inhibitors. Five days later, her vocal cord mobility, checked with flexible fiberoptic laryngoscopy, had improved, and the tracheostomy was successfully decannulated. NGT syndrome is frequently underrecognized due to its nonspecific presentation and overlap with laryngeal edema or aspiration. A high index of suspicion, timely diagnosis, and prompt tube removal with airway stabilization are essential, emphasizing the critical need for early recognition in neurocritical care.