Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Life-threatening airway obstruction accompanied by vocal cord paralysis due to indwelling nasogastric tube in malnourished elderly patients: a report of four cases

Kenzo Sakurai, M.D., Ph.D.1), Shigeaki Tanaka, M.D.1), Toshiyuki Yanagisawa, M.D., Ph.D.1), Kanako Mori, M.D., Ph.D.2), Masahiro Horiuchi, M.D., Ph.D.2) and Yasuhiro Hasegawa, M.D., Ph.D.1)

1)Department of Neurology, St. Marianna University School of Medicine
2)Department of Neurology, Kawasaki Municipal Tama Hospital

We report 4 cases of elderly patients with abrupt onset of serious airway obstruction that is presumed to be due to indwelling nasogastric tube. 2 cases are patients of cerebral infarction and 2 cases are patients of Parkinson disease. The average number of days until NGTS is 17.8 days. In all cases, fiber-optic examination revealed complete loss of adduction in both vocal cords. Infection in the posterior cricoid region caused by ulcerative lesions at the upper end of the esophagus has been implicated as a pathophysiological mechanism of this syndrome, but it was not possible to confirm in the 4 cases. Because it is difficult to exactly diagnose with NGTS in clinical practice, there is a need to consider the inducing factor and response. Body mass index is very low in each of the 4 cases, ranging from 14.2 to 18.0, implying a severely malnourished or immunocompromised state, and may represent a high risk factor for this syndrome. Whenever this life-threatening syndrome is suspected, direct vocal cord examination and removal of the tube are recommended. In addition, the clinicians should not hesitate about doing intubation or tracheotomy in emergency.
Full Text of this Article in Japanese PDF (633K)

(CLINICA NEUROL, 55: 555|560, 2015)
key words: nasogastric tube syndrome, bilateral vocal cord paralysis, malnutrition, low immune status

(Received: 22-Sep-14)