An approach to neuroleptic malignant syndrome from a clinical case

2016 ◽  
Vol 33 (S1) ◽  
pp. S631-S632 ◽  
Author(s):  
A. Gomez Peinado ◽  
P. Cano Ruiz ◽  
M.D. Sanchez Garcia ◽  
S. Cañas Fraile ◽  
M. Gonzalez Cano ◽  
...  
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Clinical Case ◽  
Medical Complication ◽  
Neuroleptic Treatment ◽  
Autonomic Nervous System Dysfunction ◽  
Electrolyte Disturbances ◽  
Starting Point ◽  
Threatening Condition ◽  
Life Threatening ◽  
Competing Interest

IntroductionNeuroleptic malignant syndrome (NMS) takes place in patients in treatment with neuroleptics and it is potentially lethal, being important an early diagnostic and therapeutic approach.ObjectivesTo analyze from a clinical case the clinical and epidemiological features, and therapeutical approach to NMS.MethodReview of some articles in Mental Health journals and analysis of the following clinical case: 68-year-old woman with bipolar disorder, hospitalized in manic phase. Usual treatment: lithium, trazodone, quetiapine and asenapine. During the admission to hospital, the patient started presenting hyperthermia, sweating, electrolyte disturbances, limb rigidity, and elevation of CPK levels. The suspicion was NMS, so neuroleptics were stopped and fluids and dantrolene were initiated, with favorable evolution.ResultsThe discharge diagnosis was NMS. Neuroleptics were gradually reintroduced under vigilance. The patient is stable and has not had new complications. NMS is an uncommon (0.02% to 3% among patients taking neuroleptic agents), but life-threatening condition. Its symptoms are hyperthermia, autonomic nervous system dysfunction, limb rigidity, altered consciousness… The attendant infections, consume of lithium, dehydration, iron deficiency and sharp changes in neuroleptic treatment are predisposing factors. The withdrawal of neuroleptics is the key of the treatment. Benzodiazepines can improve the prognosis, and electroconvulsive therapy can be necessary if there is no response to previous measures.ConclusionsNeuroleptic malignant syndrome is a life-threatening medical complication we should try to avoid by a correct and careful use of neuroleptics. Additionally, it is important the early treatment, taking withdrawal of neuroleptics as the key starting point.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Hyperthermia and neuroleptic malignant syndrome-Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s829-s830
Author(s):  
K. Puljić ◽  
M. Herceg ◽  
V. Jukić
Keyword(s):  
Malignant Hyperthermia ◽  
Neuroleptic Malignant Syndrome ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Idiosyncratic Reaction ◽  
Malignant Neuroleptic Syndrome ◽  
Neuroleptic Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Competing Interest

Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases. Malignant hyperthermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to certain drugs. The 46-years-old female patient was diagnosed schizophrenia at the age of 22. Currently, she is hospitalized due to psychotic decompensation. The patient was admitted with following daily dose therapy of: haloperidol 15 mg, biperiden 4 mg and diazepam 15 mg. During this hospitalization she developes muscle rigidity, tremor, hyperthermia, and laboratory results showed increase of enzimes CPK and LDH, so we started treatment of suspected malignant neuroleptic syndrome. After a treatment and recovery with complete withdrawal of all presented symptoms, our patient developed a malignant hypertermia that was resistant to all applicated medications. Our dilemma is whether presented symptoms of malignant hyperthermia are related to malignant neuroleptic syndrome or not?Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuroleptic Malignant Syndrome: Life-Threatening Complication of Neuroleptic Treatment in Adolescents with Affective Disorder

PEDIATRICS ◽  
1991 ◽  
Vol 87 (2) ◽  
pp. 235-239
Author(s):  
Paramjit T. Joshi ◽  
Joseph A. Capozzoli ◽  
Joseph T. Coyle
Keyword(s):  
Risk Factor ◽  
Affective Disorder ◽  
Neuroleptic Malignant Syndrome ◽  
Affective Disorders ◽  
Pediatric Population ◽  
Psychotic Symptoms ◽  
Neuroleptic Treatment ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Primary Affective Disorders

Neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal side effect of neuroleptic treatment characterized by hyperthermia, rigidity, rhabdomyolysis, and delerium. In recent clinical studies of adults it was suggested that affective disorder is a risk factor for the development of neuroleptic malignant syndrome. The cases of two adolescents with neuroleptic malignant syndrome who were treated with neuroleptic therapy because of psychotic symptoms in association with primary affective disorders are reported. The occurrence of these cases, as well as the observations in adults, suggests that attention to the primary psychiatric diagnosis is important in neuroleptic usage and that physicians should be vigilant to the occurrence of neuroleptic malignant syndrome in the pediatric population.

Malignant catatonia and neuroleptic malignant syndrome: How different/similar are they?

2016 ◽  
Vol 33 (S1) ◽  
pp. S640-S640 ◽  
Author(s):  
P. Sales ◽  
M. Bernardo ◽  
A. Lopes ◽  
E. Trigo
Keyword(s):  
Supportive Care ◽  
Neuroleptic Malignant Syndrome ◽  
Specific Treatment ◽  
Hemodynamic Instability ◽  
Psychotic Symptoms ◽  
Muscle Rigidity ◽  
Life Threatening ◽  
History Of ◽  
Competing Interest ◽  
Malignant Catatonia

IntroductionCatatonia is a neuropsychiatric syndrome that appears in medical, neurological or psychiatric conditions. There are presentation variants: “malignant catatonia” (MC) subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), possibly reflecting common pathophysiology.Objectives/methodsWe present a clinical vignette and review the literature available on online databases about MC/NMS.ResultsWe present a man, 41-years-old, black ethnicity, with no relevant medical history. He had two previous episodes compatible with brief psychosis, the last one in 2013, and a history of adverse reactions to low doses of antipsychotics. Since the last episode he was asymptomatic on olanzapine 2.5 mg id. He acutely presented to the Emergency Room with mutism, negativism, immobility and delusional speech, similar to the previous episodes mentioned and was admitted to a psychiatric infirmary, where his clinical condition worsened, showing muscle rigidity, hemodynamic instability, leukocytosis, rhabdomyolysis and fever. Supportive care was provided, olanzapine was suspended and electroconvulsive therapy (ECT) was initiated. After two months, he was discharged with no psychotic symptoms. He is still under ECT and no antipsychotic medication was reintroduced.Discussion/conclusionMany studies suggest that clinical or laboratory tests do not distinguish MC from NMS and that they are the same entity. These two conditions are life-threatening and key to treatment is a high suspicion level. There is no specific treatment; supportive care and stopping involved medications are the most widely used measures. ECT is a useful alternative to medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuroleptic malignant syndrome: Case report and literature review

2017 ◽  
Vol 41 (S1) ◽  
pp. S564-S564
Author(s):  
R. Martín Gutierrez ◽  
R. Medina Blanco ◽  
P. Suarez Pinilla ◽  
R. Landera Rodriguez ◽  
M. Juncal Ruiz ◽  
...  
Keyword(s):  
Literature Review ◽  
Neuroleptic Malignant Syndrome ◽  
Life Support ◽  
Clinical Symptoms ◽  
Altered Mental Status ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Neuroleptic Treatment ◽  
Pubmed Database ◽  
Competing Interest

IntroductionNeuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.ObjectiveTo review the incidence, clinical characteristics, diagnosis and treatment of NMS.AimWe have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.MethodsA literature review of the NMS was performed using the PubMed database.ResultsThe frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.ConclusionsNMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Endovascular Embolization of Gastroduodenal Artery in its Pancreatogenous Arrosia: a Clinical Case

2019 ◽  
Vol 64 (6) ◽  
pp. 88-90
Author(s):  
M. Popov ◽  
S. Voskanyan ◽  
A. Dunaev ◽  
A. Bashkov ◽  
M. Aronov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Case ◽  
Pancreatic Pseudocyst ◽  
Pancreatic Head ◽  
Endovascular Embolization ◽  
Gastroduodenal Artery ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Vascular Structures

Arrosion of the peripancreatic vascular structures is a rare, but life-threatening condition and requires surgical treatment. One of the most common causes of arrosia is the presence of pancreatic pseudocyst. Imaging methods play a crucial role not only in terms of identifying the described pathology, but also in planning the tactics of surgical treatment. We present a clinical case of a patient, a 44-year-old male, with pseudocyst in the pancreatic head in the presence of chronic pancreatitis, complicated by bleeding into its cavity as a result of an arrosion of the gastroduodenal artery, which required endovascular embolization and drainage of the pseudocyst. This clinical case shows the possibility of endovascular embolization of the injured gastroduodenal artery with microspirals.

scholarly journals Managing venous thromboembolic events in daily practise: ‘‘time is never enough’’

2016 ◽  
Vol 71 (2) ◽  
Author(s):  
D. Anyfantakis ◽  
E.K. Symvoulakis ◽  
I. Mitrouska
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Practice ◽  
Clinical Case ◽  
Daily Clinical Practice ◽  
Thromboembolic Events ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Threatening Condition ◽  
Life Threatening

Pulmonary embolism is an insidious life-threatening condition. Its diagnosis represents a challenging topic in daily clinical practice since the recognition and the appropriate management of the condition can lead to the decrease of potentially fatal consequences. We present a clinical case which highlights the necessity for an increased level of ‘surveillance’ from the involved physicians since features of thromboembolic events may be elusive or vague.

scholarly journals Is severe hypocalcemia immediately life threatening?

2018 ◽  
Vol 7 (10) ◽  
pp. 1067-1074 ◽  
Author(s):  
Maxime Duval ◽  
Kalyane Bach-Ngohou ◽  
Damien Masson ◽  
Camille Guimard ◽  
Philippe Le Conte ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Neurological Complication ◽  
Neurological Complications ◽  
University Hospital ◽  
Electrolyte Disturbances ◽  
Concentration Measure ◽  
Threatening Condition ◽  
Life Threatening ◽  
Precise Role

Objective Severe hypocalcemia (Ca <1.9 mmol/L) is often considered an emergency because of a potential risk of cardiac arrest or seizures. However, there is little evidence to support this. The aim of our study was to assess whether severe hypocalcemia was associated with immediately life-threatening cardiac arrhythmias or neurological complications. Methods A retrospective observational study was carried out over a 2-year period in the Adult Emergency Department (ED) of Nantes University Hospital. All patients who had a protein-corrected calcium concentration measure were eligible for inclusion. Patients with multiple myeloma were excluded. The primary outcome was the number of life-threatening cardiac arrhythmias and/or neurological complications during the stay in the ED. Results A total of 41,823 patients had protein-corrected calcium (pcCa) concentrations measured, 155 had severe hypocalcemia, 22 were excluded because of myeloma leaving 133 for analysis. Median pcCa concentration was 1.73 mmol/L (1.57–1.84). Seventeen (12.8%) patients presented a life-threatening condition, 14 (10.5%) neurological and 3 (2.2%) cardiac during ED stay. However, these complications could be explained by the presence of underlying co-morbidities and or electrolyte disturbances other than hypocalcemia. Overall, 24 (18%) patients died in hospital. Vitamin D deficiency, chronic kidney disease and hypoparathyroidism were the most frequently found causes of hypocalcemia. Conclusion Thirteen percent of patients with severe hypocalcemia presented a life-threatening cardiac or neurological complication on the ED. However, a perfectly valid alternative cause could account for these complications. Further research is warranted to define the precise role of hypocalcemia.

scholarly journals Celiac Crisis in a Young Woman: Raising Awareness of a Life-Threatening Condition

2019 ◽  
Vol 11 (4) ◽  
pp. 230-233
Author(s):  
Maryam Jameshorani ◽  
Akram Pourshams ◽  
Anahita Sadeghi ◽  
Hiva Saffar ◽  
Reza Malekzadeh
Keyword(s):  
Celiac Disease ◽  
Herbal Medicines ◽  
Hemodynamic Instability ◽  
Deficiency Anemia ◽  
Electrolyte Disturbances ◽  
Celiac Crisis ◽  
Raising Awareness ◽  
Clinical Presentations ◽  
Threatening Condition ◽  
Life Threatening

Celiac crisis is a rare, acute, and life-threatening presentation of celiac disease. Its clinical presentations consist of severe watery non-bloody diarrhea, electrolyte disturbances (i.e. hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and metabolic acidosis), hypoproteinemia, and dehydration. Here we present a 33-year-old woman who referred with profuse diarrhea, weight loss, hemodynamic instability, hypokalemia, hypoproteinemia, ascites, pancytopenia, and iron deficiency anemia. She used herbal medicines for constipation and had severe weakness after her childbirth. The patient was diagnosed as having celiac disease through pathological and serological evaluations 10 months earlier. Diagnosis of celiac crisis after ruling out the other causes of resistant celiac was made and she was treated with steroids.

scholarly journals Diagnostic uncertainty in a case of neuroleptic malignant syndrome

CJEM ◽  
2005 ◽  
Vol 7 (04) ◽  
pp. 266-272 ◽  
Author(s):  
Dallas P. Seitz
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Criteria ◽  
Neuroleptic Malignant Syndrome ◽  
Muscle Rigidity ◽  
Atypical Presentation ◽  
Diagnostic Uncertainty ◽  
Threatening Condition ◽  
Life Threatening ◽  
Psychiatric Conditions ◽  
Delays In Diagnosis

ABSTRACTNeuroleptic malignant syndrome (NMS) is a potentially life-threatening condition that has been associated with antipsychotic use. Most diagnostic criteria include fever and muscle rigidity, although NMS may present without either. Diagnostic uncertainty in such cases may result in delays in diagnosis and management, leading to adverse consequences for these patients. The differential diagnosis of NMS is broad and includes a number of neurological, medical and psychiatric conditions as well as substance and medication-induced disorders. A case is described that illustrates an atypical presentation of NMS and demonstrates some of the challenges in its diagnosis. Limitations of current NMS criteria are also examined, and suggestions for future criteria are presented.

scholarly journals Primary adrenal insufficiency in adult population: a Portuguese Multicentre Study by the Adrenal Tumours Study Group

2017 ◽  
Vol 6 (8) ◽  
pp. 935-942 ◽  
Author(s):  
Lia Ferreira ◽  
João Silva ◽  
Susana Garrido ◽  
Carlos Bello ◽  
Diana Oliveira ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Adult Population ◽  
Serum Cortisol ◽  
High Plasma ◽  
Adrenal Crisis ◽  
Primary Adrenal Insufficiency ◽  
Electrolyte Disturbances ◽  
Threatening Condition ◽  
Life Threatening ◽  
Portuguese Study

Introduction Primary adrenal insufficiency (PAI) is a rare but severe and potentially life-threatening condition. No previous studies have characterized Portuguese patients with PAI. Aims To characterize the clinical presentation, diagnostic workup, treatment and follow‐up of Portuguese patients with confirmed PAI. Methods This multicentre retrospective study examined PAI patients in 12 Portuguese hospitals. Results We investigated 278 patients with PAI (55.8% were females), with a mean age of 33.6 ± 19.3 years at diagnosis. The most frequent presenting clinical features were asthenia (60.1%), mucocutaneous hyperpigmentation (55.0%) and weight loss (43.2%); 29.1% of the patients presented with adrenal crisis. Diagnosis was established by high plasma ACTH and low serum cortisol in most patients (43.9%). The most common aetiology of PAI was autoimmune adrenalitis (61.0%). There were 38 idiopathic cases. Autoimmune comorbidities were found in 70% of the patients, the most frequent being autoimmune thyroiditis (60.7%) and type 1 diabetes mellitus (17.3%). Seventy-nine percent were treated with hydrocortisone (mean dose 26.3 ± 8.3 mg/day) mostly in three (57.5%) or two (37.4%) daily doses. The remaining patients were treated with prednisolone (10.1%), dexamethasone (6.2%) and methylprednisolone (0.7%); 66.2% were also on fludrocortisone (median dose of 100 µg/day). Since diagnosis, 33.5% of patients were hospitalized for disease decompensation. In the last appointment, 17.2% of patients had complaints (7.6% asthenia and 6.5% depression) and 9.7% had electrolyte disturbances. Conclusion This is the first multicentre Portuguese study regarding PAI. The results emphasize the need for standardization in diagnostic tests and etiological investigation and provide a framework for improving treatment.

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