Neuroleptic malignant syndrome: risk factors, pathophysiology, and treatment

2004 ◽  
Vol 16 (4) ◽  
pp. 219-228 ◽  
Author(s):  
Jambur Ananth ◽  
Kamala Aduri ◽  
Sharath Parameswaran ◽  
Sarath Gunatilake
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Heat Stroke ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Active Phase ◽  
Initial Step ◽  
Antipsychotic Agents ◽  
Patient Treatment ◽  
Low Grade ◽  
Dopamine Receptor Antagonists

Neuroleptic malignant syndrome (NMS) is associated with the administration of antipsychotic agents and other drugs such as l-dopa, antidepressants, and antihistaminic agents. Unexpected changes in mental status, new-onset catatonia, episodic tachycardia, tachypnea, hypertension, dysarthria, dysphagia, diaphoresis, sialorrhea, incontinence, low-grade temperature elevations, and rigidity should arouse suspicion. Several lines of evidence provide support for the involvement of dopamine. Most of the drugs implicated in NMS are D2 dopamine receptor antagonists. Central noradrenergic activity is also possibly related to the disorder, as sympathetic hyperactivity is associated with the active phase of NMS. Currently, the definitive role of GABA deficiency in NMS is yet to be established. Differential diagnosis should include malignant hyperthermia, lethal catatonia, lithium toxicity, serotonin syndrome, and heat stroke. A high degree of suspicion and the discontinuation of antipsychotic agents even if the diagnosis is not established are essential for the safety of the patient. Treatment of NMS should be individualized and be based empirically on the character, duration, and severity of the clinical signs and symptoms noted. The initial step in the treatment of NMS is the removal of the offending agent. Full-blown NMS is a serious condition and requires immediate supportive, nutritive, and electrolyte therapies. The administration of drugs that can improve NMS, such as IV dantrolene and/or oral bromocriptine, may also be taken into consideration, based on the severity and nature of the NMS.

scholarly journals Amoebae in Chronic, Polymicrobial Endodontic Infections Are Associated with Altered Microbial Communities of Increased Virulence

2020 ◽  
Vol 9 (11) ◽  
pp. 3700
Author(s):  
Garrit Koller ◽  
Federico Foschi ◽  
Philip Mitchell ◽  
Elizabeth Witherden ◽  
Kenneth Bruce ◽  
...  
Keyword(s):  
Microbial Communities ◽  
High Throughput Sequencing ◽  
Inflammatory Responses ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Resistant Bacteria ◽  
Low Grade ◽  
Taxonomic Assignment ◽  
Microbial Composition ◽  
Endodontic Infections

Background: Infections of the root canal space involve polymicrobial biofilms and lead to chronic, low grade inflammatory responses arising from the seeding of microbes and by-products. Acute exacerbation and/or disseminating infections occur when established microbial communities undergo sudden changes in phenotypic behaviour. Methods: Within clinical endodontic infections, we assessedcategorical determinants comprising, and changing microbial composition of, chronic polymicrobial infections and their association with amoebae. After standardised assessment, primary or secondary infections underwent sampling and DNA processing, targeting bacteria, fungi and amoebae, including 16S high-throughput sequencing. After taxonomic assignment, community composition was correlated with clinical signs and symptoms. Diversity and abundance analyses were carried out in relation to the presence of non-bacterial amplicons. Results: Clinical specimens revealed two distinct community clusters, where specific changes correlated with clinical signs. An association between the compositions of microbiomes was found between these groups and the presence of Entamoeba gingivalis in 44% of cases. When amoebae were present in endodontic infections, we demonstrate changes in microbial community structure that mirror those observed in treatment-resistant or recurrent infections. Conclusions: Amoeba are present in endodontic infections at a high prevalence, and may promote increased virulence by enrichment for phagocytosis-resistant bacteria.

The Burden of Neurosarcoidosis: Essential Approaches to Early Diagnosis and Treatment

2020 ◽  
Vol 41 (05) ◽  
pp. 641-651
Author(s):  
Mareye Voortman ◽  
Barney J. Stern ◽  
Lesley Ann Saketkoo ◽  
Marjolein Drent
Keyword(s):  
Disease Activity ◽  
Stress Reduction ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Active Phase ◽  
Leptomeningeal Disease ◽  
Activity Levels ◽  
Cranial Nerve Dysfunction ◽  
Organ Specific ◽  
Clinical Signs And Symptoms

AbstractNeurosarcoidosis (NS) is an often severe, destructive manifestation with a likely under-reported prevalence of 5 to 15% of sarcoidosis cases, and in its active phase demands timely treatment intervention. Clinical signs and symptoms of NS are variable and wide-ranging, depending on anatomical involvement. Cranial nerve dysfunction, cerebrospinal parenchymal disease, aseptic meningitis, and leptomeningeal disease are the most commonly recognized manifestations. However, non-organ-specific potentially neurologically driven symptoms, such as fatigue, cognitive dysfunction, and small fiber neuropathy, appear frequently.Heterogeneous clinical presentations and absence of any single conclusive test or biomarker render NS, and sarcoidosis itself, a challenging definitive diagnosis. Clinical suspicion of NS warrants a thorough systemic and neurologic evaluation hopefully resulting in supportive extraneural physical exam and/or tissue findings. Treatment targets the severity of the manifestation, with careful discernment of whether NS reflects active potentially reversible inflammatory granulomatous disease versus inactive postinflammatory damage whereby functional impairment is unlikely to be pharmacologically responsive. Non-organ-specific symptoms are poorly understood, challenging in deciphering reversibility and often identified too late to respond to conventional immunosuppressive/pharmacological treatment. Physical therapy, coping strategies, and stress reduction may benefit patients with all disease activity levels of NS.This publication provides an approach to screening, diagnosis, disease activity discernment, and pharmacological as well as nonpharmacological treatment interventions to reduce disability and protect health-related quality of life in NS.

Neuroleptic malignant syndrome

2011 ◽  
Vol 26 (S2) ◽  
pp. 1235-1235
Author(s):  
A. Cruz
Keyword(s):  
Risk Factors ◽  
Neuroleptic Malignant Syndrome ◽  
Rare Complication ◽  
Clinical Signs ◽  
Specific Treatment ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Altered Mental Status ◽  
Antipsychotic Therapy ◽  
Mesh Terms

IntroductionNeuroleptic malignant syndrome (NMS) is a rare and potentially fatal idiosyncratic drug reaction usually defined as a complication of treatment with antipsychotics. It is manifested by altered mental status, hyperpyrexia, rigidity and autonomic instability. This syndrome occurs in response to administration of drugs that induce dopamine blockage.ObjectivesStudy the risk factors, diagnosis, treatment and complications of NMS, by performing a literature review.AimsSummarize the main aspects of NMS that may have importance in usual clinical practice.MethodsPubMed was used to identify NMS articles published after 2000, associated with the MeSH terms “neuroleptic malignant syndrome” and “antipsychotic agents”.ResultsNMS is not dose-related and its aetiology is still unknown. There are many risk factors associated with the syndrome, such as demographic, individual, genetic and environmental factors and medication. In order to evaluate the medical situation, an accurate clinical history and physical examination should be fulfilled. NMS is also characterized by changes in laboratory investigation. There are no patognomonic findings, thus other different diagnosis should be considered. Specific treatment remains controversial. Treatment should be individualized for each patient, regarding characteristics, duration and severity of the clinical signs and symptoms. Resolution is usually verified in one to two weeks. Though there are cases in which the symptoms persist and comorbid process may occur.ConclusionsAlthough NMS is a rare complication of antipsychotic therapy, early diagnosis and treatment is essential to improve prognosis.

scholarly journals Histopathological study of cystoscopic bladder biopsies

2015 ◽  
Vol 5 (9) ◽  
pp. 717-719
Author(s):  
R Baidya ◽  
B Sigdel ◽  
NL Baidhya
Keyword(s):  
Urinary Bladder ◽  
Transitional Cell ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Developed Countries ◽  
Histopathological Study ◽  
Low Grade ◽  
Neoplastic Lesions ◽  
Clinical Signs And Symptoms ◽  
Hematoxylin And Eosin Stain

Background: Urinary bladder diseases constitute an important source of clinical signs and symptoms which are more disabling than lethal. The prevalence of bladder tumor in developed countries is approximately six times higher compared with that in developing countries. The aim of this study was to find out various lesions in urinary bladder biopsies and its frequencies.Materials and Methods: This was a five year retrospective study from January 2008 to December 2013, carried out at B&B Hospital, Lalitpur. All the relevant data of 324 patients who had undergone cystoscopic biopsy of urinary bladder were included in the study. All blocks were retrieved and stained with Hematoxylin and Eosin stain and examined under light microscope.Results: The spectrum of pathological lesions included inflammations and tumors. Non-neoplastic lesions were predominant (61.11%) followed by Transitional cell tumors accounted for 124 cases (38.27%). Non-neoplastic lesions comprises of cystitis and tuberculosis. Papillary urothelial neoplasms was the most common tumors seen in this study with 55 low grade, and 54 high grade Papillary urothelial carcinoma according to recent WHO grading. Single cases each of adenocarcinoma and paraganglioma were diagnosed.Conclusion: Cystoscopic biopsies help in the early diagnosis and treatment of various bladder lesions. Analysis of cystoscopic biopsies was done to ascertain the type of urinary bladder lesions in our country.Journal of Pathology of Nepal (2015) Vol. 5, 717-719

Neuroleptic Rechallenge after Neuroleptic Malignant Syndrome: Case Report and Literature Review

1988 ◽  
Vol 22 (6) ◽  
pp. 475-480 ◽  
Author(s):  
Amy J. Wells ◽  
Roger W. Sommi ◽  
M. Lynn Crismon
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Signs And Symptoms ◽  
Antipsychotic Agent ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Muscle Rigidity ◽  
Close Monitoring ◽  
Altered Level ◽  
Time Period ◽  
Level Of Consciousness

Neuroleptic malignant syndrome (NMS) is associated with essentially all of the currently available antipsychotic agents. The signs and symptoms associated with the syndrome are hyperpyrexia, defined by body temperature > 38°C; extreme muscle rigidity, with or without elevated creatine Phosphokinase or hyperreflexia; and other symptoms such as altered level of consciousness and/or autonomic dysfunction as manifested by labile blood pressure, tachycardia, tachypnea, urinary or fecal incontinence, pallor, or diaphoresis. This potentially fatal syndrome complicates the treatment of patients with recurrent psychotic symptoms because of the possibility for recurrence of the NMS. A case of recurrent NMS is presented in which the patient was rechallenged with an antipsychotic agent. In addition, 41 reported cases of antipsychotic rechallenge after NMS are reviewed. The results of the review suggest that neuroleptic rechallenge following NMS is associated with an acceptable risk of recurrence in most patients. However, close monitoring for NMS and careful selection of patients for antipsychotic rechallenge is mandatory. A minimal time period of five days before rechallenge may also reduce the risk of recurrent NMS. Recurrence was not associated with patient age or gender, nor the antipsychotic agent used.

scholarly journals Side effects of antipsychotic agents: Neuroleptic malignant syndrome

2010 ◽  
Vol 63 (9-10) ◽  
pp. 705-708 ◽  
Author(s):  
Mina Cvjetkovic-Bosnjak ◽  
Branislava Soldatovic-Stajic
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotics ◽  
Signs And Symptoms ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Symptomatic Therapy ◽  
Idiosyncratic Reaction ◽  
Hypothalamic Nuclei ◽  
Life Threatening ◽  
Possible Cause

Neuroleptic malignant syndrome is a rare, potentially life-threatening complication which is an unpredictable, idiosyncratic reaction to antipsychotics. In patients receiving traditional antipsychotics, neuroleptic malignant syndrome occurs with an incidence of 0.2-3.3%. However, neuroleptic malignant syndrome also appears in patients treated with atypical antipsychotics, especially Clozapine. A possible cause of neuroleptic malignant syndrome is blockade of dopamine receptors in the nigrostriatal tracts or hypothalamic nuclei. If signs and symptoms of the Neuroleptic malignant syndrome are identified in time, full recovery is possible. This is a report of a female patient with neuroleptic malignant syndrome treated by traditional antipsychotics. As soon as neuroleptic malignant syndrome symptoms were recognized, the antipsychotic drugs were discontinued, symptomatic therapy was initiated and symptoms of neuroleptic malignant syndrome disappeared. However, the patient's psychotic symptoms persisted and an atypical antipsychotic was administered. During the next few days the psychotic symptoms gradually disappeared and the patient accomplished good recovery.

scholarly journals Round Table on Malignant Hyperthermia in Physically Active Populations: Meeting Proceedings

2017 ◽  
Vol 52 (4) ◽  
pp. 377-383 ◽  
Author(s):  
Yuri Hosokawa ◽  
Douglas J. Casa ◽  
Henry Rosenberg ◽  
John F. Capacchione ◽  
Emmanuel Sagui ◽  
...  
Keyword(s):  
Malignant Hyperthermia ◽  
Athletic Training ◽  
Task Force ◽  
Case Reports ◽  
Heat Stroke ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Round Table ◽  
Expert Consensus ◽  
Physically Active

Context:  Recent case reports on malignant hyperthermia (MH)-like syndrome in physically active populations indicate potential associations among MH, exertional heat stroke (EHS), and exertional rhabdomyolysis (ER). However, an expert consensus for clinicians working with these populations is lacking. Objective:  To provide current expert consensus on the (1) definition of MH; (2) history, etiology, and pathophysiology of MH; (3) epidemiology of MH; (4) association of MH with EHS and ER; (5) identification of an MH-like syndrome; (6) recommendations for acute management of an MH-like syndrome; (7) special considerations for physically active populations; and (8) future directions for research. Setting:  An interassociation task force was formed by experts in athletic training, exercise science, anesthesiology, and emergency medicine. The “Round Table on Malignant Hyperthermia in Physically Active Populations” was convened at the University of Connecticut, Storrs, September 17–18, 2015. Conclusions:  Clinicians should consider an MH-like syndrome when a diagnosis of EHS or ER cannot be fully explained by clinical signs and symptoms presented by a patient or when recurrent episodes of EHS or ER (or both) are unexplained. Further research is required to elucidate the genetic and pathophysiological links among MH, EHS, and ER.

scholarly journals Primary intracranial germ cell tumour originating from right brachium Pontis with hypertrophic Olivary degeneration: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanong Li ◽  
Peng Wang ◽  
Jin Feng ◽  
Jiayi Wang ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Preoperative Diagnosis ◽  
Demyelinating Disease ◽  
Germ Cell Tumour ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Neurological Deficits ◽  
Low Grade ◽  
Ataxic Gait ◽  
Intracranial Germinoma ◽  
Hypertrophic Olivary Degeneration

Abstract Background Primary right brachium pontis germinoma with hypertrophic olivary degeneration (HOD) is extremely rare. A preoperative diagnosis is challenging due to the absence of characterized clinical and neuroimaging features, and biopsy should be considered. Case presentation A 20-year-old male patient presented with a case of primary intracranial germinoma originating from right brachium pontis with HOD manifesting as ocular myoclonus, nystagmus in both eyes, ataxic gait and incoordination of the limbs. Magnetic resonance imaging (MRI) revealed an irregular patchy lesion with hyperintensity on T2-weighted images (T2WI) and T2 fluid-attenuated inversion recovery (FLAIR) without enhancement by gadolinium (Gd). Furthermore, a focal hyperintense nodule on T2WI in the left inferior olive nucleus (ION) of the medulla oblongata was considered hypertrophic olivary degeneration (HOD) based on the patient’s symptoms and neuroimaging findings. Due to suspected demyelinating disease and low-grade glioma (LGG), a biopsy was planned. The pathological diagnosis was germinoma. Subsequently, he received chemoradiation therapy, resulting in the improvement of neurological deficits and the disappearance of the lesion on MRI. Conclusion A case of “Primary right brachium pontis germinoma with HOD” is reported for the first time. A preoperative diagnosis is challenging due to the fact of absence of clinical signs and symptoms and neuroimaging characteristics. However, patients can have favourable prognoses with appropriate evaluation and treatment.

scholarly journals Migratory Glossitis Associated with Cleft Tongue: Case Report

2021 ◽  
Vol 23 (2) ◽  
pp. 113-115
Author(s):  
Samira Vilela Prado Mascarenhas ◽  
Vanessa de Sousa ◽  
Andrei Rosa ◽  
Rodrigo Lacerda de Barros ◽  
Luiz Evaristo Ricci Volpato
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Burning Sensation ◽  
Patient Treatment ◽  
Oral Medicine ◽  
Lingual Papillae ◽  
Main Complaint ◽  
Increased Sensitivity ◽  
Cleft Tongue ◽  
Fissured Tongue

AbstractBenign migratory glossitis, also known as geographic tongue, is characterized by the tongue inflammation and is associated with pain and difficulty eating due to the lingual papillae atrophy. It may appear in association with the fissured tongue. This paper reports the case of a 47-year-old male patient who sought dental care with the main complaint of burning, discomfort, increased sensitivity and a burning sensation on the tongue. He was diagnosed with migratory glossitis associated with a fissured tongue. The patient treatment was performed with an ointment based on triamcinolone acetonide (Omcilon- A Orabase®), which showed improvement in the clinical signs after seven days. The therapy used in this patient was effective in restoring the tongue papillae and improving signs and symptoms. Keywords: Glossitis, Benign Migratory. Tongue, Fissured. Oral Medicine ResumoA glossite migratória benigna, também conhecida como língua geográfica, caracteriza-se por inflamação da língua e está associada a dor e dificuldade na alimentação devido a atrofia das papilas linguais. Pode aparecer em associação à língua fissurada. Este trabalho relata o caso de um paciente do sexo masculino com idade de 47 anos que buscou atendimento odontológico com queixa principal de ardência, desconforto, sensibilidade aumentada e sensação de queimação na língua. Foi diagnosticado com glossite migratória associada a língua fissurada. O tratamento do paciente foi realizado com pomada à base de triancinolona acetonida (Omcilon- A Orabase®) demonstrou melhora no quadro clinico após sete dias. A terapêutica usada neste paciente foi eficaz no restabelecimento das papilas da língua e melhora dos sinais e sintomas. Palavras-chave: Glossite Migratória Benigna. Língua Fissurada. Medicina Bucal.

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