Acute basagranTM poisoning mimicking neuroleptic malignant syndrome

1999 ◽  
Vol 18 (8) ◽  
pp. 493-494 ◽  
Author(s):  
T-J Lin ◽  
D-Z Hung ◽  
W-H Hu ◽  
D-Y Yang ◽  
T-C Wu
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Sinus Tachycardia ◽  
Signs And Symptoms ◽  
Muscle Rigidity ◽  
Clinical Presentations ◽  
Surgical History ◽  
Commit Suicide

A 27-year-old robust man, without any medical and surgical history, attempted to commit suicide by consumption of 300 cc (44.1%, 132.3 g) basagranTM, a readily available herbicide. This poisoning resulted in vomiting, fever, sweating, pipe-like muscle rigidity, sinus tachycardia, drowsiness, leukocytosis, rhabdomyolysis and hepatorenal damage. Emperical treatment with bromocriptine was temporally associated with resolution of above signs and symptoms. His clinical presentations and the effect of bromocriptine may be indicative that basagranTm poisoning mimicks neuroleptic malignant syndrome.

scholarly journals A Case of Neuroleptic Malignant Syndrome in a Profoundly Intellectually Disabled Patient with Successful Reintroduction of Antipsychotic Therapy with Quetiapine

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Kamal Patel ◽  
Brandon Lilly ◽  
Oluwadamilare Ajayi ◽  
Kelly Melvin
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
First Generation ◽  
Early Recognition ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Antipsychotic Agent ◽  
Muscle Rigidity ◽  
Status Change ◽  
Antipsychotic Therapy ◽  
Autonomic Instability

Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomic instability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychotic medications; though, other neuroleptics have been implicated as well. NMS can be fatal with estimated mortality rates as high as 20%. Patients experiencing certain severe complications, including renal failure, have been associated with mortality as high as 50%, stressing the need for early recognition and treatment. Here we present the case of a 54-year-old male that initially presented with symptoms suspicious for sepsis, but who eventually developed a clinical picture consistent with NMS. We describe the diagnostic and treatment process leading to symptom remission. We then discuss our decision to reintroduce an atypical antipsychotic agent, quetiapine. This case illustrates the importance of early recognition of the signs and symptoms of NMS and the need to initiate treatment promptly in order to prevent complications, including death. This case also highlights the decision to resume antipsychotic pharmacotherapy after adequate resolution of NMS, demonstrating that it can be done so safely if started at low doses coupled with intensive monitoring of the patient.

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.

Successful clozapine rechallenge following clozapine-induced neuroleptic malignant syndrome

2015 ◽  
Vol 5 (2) ◽  
pp. 88-90 ◽  
Author(s):  
Clint Ross
Keyword(s):  
Adverse Effect ◽  
Neuroleptic Malignant Syndrome ◽  
Mental Status ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Treatment Resistant ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Potential Risks

Abstract Neuroleptic malignant syndrome (NMS) is a potential life-threatening adverse effect of antipsychotics. Characteristic signs and symptoms of NMS include hyperthermia, muscle rigidity, altered mental status, and autonomic instability. Treatment of NMS includes discontinuation of any antipsychotic or other potentially offending agents. This report describes the details of a patient diagnosed with NMS induced by clozapine with subsequent successful rechallenge. Given limited therapeutic options for patients with treatment-resistant schizophrenia, clinicians should be cognizant of potential risks but aware of the possibility of successful rechallenge with clozapine.

Neuroleptic Malignant Syndrome in a Patient With Anti-N-Methyl-D-Aspartate Receptor Encephalitis: Case Report and Review of Related Literature

2021 ◽  
pp. 194187442110029
Author(s):  
Robert Joseph C. Sarmiento ◽  
Jose Danilo B. Diestro ◽  
Athena Kate D. Antonio ◽  
Mario B. Prado ◽  
Karen Joy B. Adiao ◽  
...  
Keyword(s):  
Case Report ◽  
Intravenous Immunoglobulin ◽  
Neuroleptic Malignant Syndrome ◽  
Signs And Symptoms ◽  
Ovarian Teratoma ◽  
High Dose ◽  
Muscle Rigidity ◽  
Diagnostic Dilemma ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe but treatable disease that presents with symptoms similar to neuroleptic malignant syndrome (NMS). Case Report: We describe a 28-year old female who initially presented with headaches, behavioral changes, anxiety, lip tremors, and rigidity of extremities. She was prescribed with olanzapine and later manifested with neuroleptic malignant syndrome symptoms such as decrease in sensorium, muscle rigidity, hyperthermia and tachycardia. Further investigation showed presence of bilateral ovarian teratoma and anti-NMDAR antibodies in her serum and cerebrospinal fluid. Symptoms resolved after intravenous high-dose methylprednisolone, bilateral oophoro-cystectomy, and intravenous immunoglobulin administration. Overlapping pathological mechanisms of anti- NMDAR encephalitis and NMS were discussed. Ten patients with anti- NMDAR encephalitis and NMS were noted in a review of literature. Prognosis was favorable and intervention ranged from supportive to methylprednisolone and intravenous immunoglobulin administration, plasma exchange and teratoma resection. Conclusion: Anti- NMDAR encephalitis patients are at risk for NMS due to antipsychotic intolerance and other interrelated pathophysiological mechanisms. The overlap between the signs and symptoms of anti-NMDAR encephalitis and NMS poses a diagnostic dilemma and warrants a careful investigation and management.

scholarly journals Neuroleptic malignant syndrome

2011 ◽  
Vol 69 (5) ◽  
pp. 751-755 ◽  
Author(s):  
Mariana Moscovich ◽  
Felipe T.M. Nóvak ◽  
Artur F. Fernandes ◽  
Tatiana Bruch ◽  
Tabita Tomelin ◽  
...  
Keyword(s):  
Adverse Event ◽  
Neuroleptic Malignant Syndrome ◽  
Fatal Outcome ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Past Medical History ◽  
History Of ◽  
High Doses ◽  
Symptoms And Signs ◽  
Gathering Data

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS.

scholarly journals TO STUDY THE INCIDENCES OF CARDIAC MANIFESTATION IN THYROID DISORDER (HYPO & HYPER) BOTH IN RURAL AREA OF MALWA REGION

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Ravija Prasad Ram ◽  
Dr. Divyesh Lad ◽  
Dr. Badri Vishal Singh ◽  
Dr. Arihant Jain
Keyword(s):  
Pulse Pressure ◽  
Sinus Tachycardia ◽  
Heart Sound ◽  
Sinus Bradycardia ◽  
Signs And Symptoms ◽  
Thyroid Disorder ◽  
Diastolic Hypertension ◽  
Prolonged Qt Interval ◽  
Cardiac Manifestation ◽  
Almost All

Background: In this study 100 cases of thyroid dysfunction were studied for the cardiovascular manifestations. Out of these, 60 cases were of hypothyroidism and 40 cases were of hyperthyroidism. There was no age bar for inclusion in the study. All of these cases were selected from those attending the Endocrinology OPD in IMCHRC hospital, Indore. Result: Low pulse pressure is the commonest cardiovascular finding in hypothyroidism (68.33%) followed by diastolic hypertension (55%), soft heart murmur (31.66%), sinus bradycardia (30%) and pericardial effusion (20%) Pulse pressure >40 mm of Hg is the commonest finding in hyperthyroidism. Almost all patients of hyperthyroidism have sinus tachycardia. Conclusion: Study of cardiac signs and symptoms in patient with hyperthyroidism revealed 87.5% prevalence of pulse pressure > 40 mm hg, 85% prevalence of loud heart sound, 82.5% cases of sinus tachycardia, 52.5% cases of hyperdynamic precordium, 47.5% cases of ejection systolic murmur, 42.5% cases of prolonged Qt interval, 25% cases of precordial thrill, 47.5% patients with systolic BP>160 mm Hg, 20 5 cases with mid systolic click, 27.5% patients with LVH , 15% cases with ST-T changes, 5% cases with S3 and 10% patients with atrial fibrillation. Keywords: Cardiac, Manifestation, Thyroid, Hyperthyroidism & Hypothyroidism.

Breast and endocrine surgery

2014 ◽  
Author(s):  
Asmaa Al-Alaak
Keyword(s):  
Treatment Options ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Breast Disease ◽  
Endocrine Surgery ◽  
Endocrine Disease ◽  
Surgical Disease ◽  
Clinical Presentations ◽  
Basic Facts ◽  
Clinical Signs And Symptoms

One of the main ‘complaints’ about breast disease is that ‘it is all so similar’ and that there are lots of treatment options which can seem confusing at first. The key to understanding breast disease and preparing for questions about it is to keep the basic facts about breast anatomy and pathology to the forefront, learn to recognize key patterns of clinical signs and symptoms, and then match them to the clinical scenario. The EMQs are particularly useful at practising fitting questions into clinical patterns and rehearsing the patterns. Endocrine disease poses its own challenges. Even for a surgeon it is important to understand and recognize the underlying biochemistry and how this affects the clinical presentations. Endocrine surgical disease is much less about anatomy or surgical procedures themselves as it is about understanding how treatment is matched to the pathophysiology of the conditions.

Routine Vaccines for Vaccine-Preventable Diseases

2017 ◽  
Author(s):  
Tina Q. Tan ◽  
John P. Flaherty ◽  
Melvin V. Gerbie
Keyword(s):  
Natural History ◽  
Infectious Diseases ◽  
Signs And Symptoms ◽  
Vaccine Preventable Diseases ◽  
Post Exposure ◽  
Clinical Presentations ◽  
Incubation Periods ◽  
Prevention And Treatment

The natural history, signs and symptoms, prevention, and treatment of common vaccine preventable infectious diseases are introduced. Dosing, immunization schedules, contraindications, precautions, and administration of vaccines are discussed for patients of all ages. Frequently asked question sections at the end of each chapter summarize issues that clinicians commonly encounter in their practices. This chapter details each of the diseases and specific vaccines that are recommended throughout life. The clinical presentations, clinical courses, complications, and post-exposure and pre-exposure managements are detailed. Differences in the disease in childhood and adult ages are noted. International variations of the diseases and vaccine requirements of individual countries are noted. The transmissions, incubation periods of the diseases, natural, and vaccine-induced durations of immunity are discussed. FAQs offer helpful answers to many of the questions that this wide variety of conditions present.

Neuroleptic Malignant Syndrome – A medical emergency in a psychiatric patient

2018 ◽  
Vol 6 (2) ◽  
pp. 108-110
Author(s):  
Rajib Ahsan Sumon ◽  
Eshita Majumder
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Complete Resolution ◽  
Antipsychotic Drugs ◽  
Medical Emergency ◽  
Muscle Rigidity ◽  
Atypical Antipsychotic Drug ◽  
Presumptive Diagnosis ◽  
Idiosyncratic Reaction ◽  
High Fatality Rate ◽  
Work Up

With an estimated incidence of 0.02 to 3.23%1, neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to antipsychotic drugs; having a relatively high fatality rate of about 10%2. Here, we are reporting, a 38 years old female schizoaffective patient, presented with fever, muscle rigidity and altered sensorium who had started tablet risperidone(an atypical antipsychotic drug) 11 days prior to hospital admission. After initial sepsis work up and neuroimaging, infective causes and acute cerebrovascular incidents were ruled out and a presumptive diagnosis of NMS was made. Immediate discontinuation of suspected causative agent, along with the provision of supportive care leads to complete resolution of all the symptoms in our patient.Bangladesh Crit Care J September 2018; 6(2): 108-110

scholarly journals Haemophagocytic Lymphohistiocytosis: A Case Report and Short Overview

2018 ◽  
Vol 10 (1) ◽  
pp. 51-58
Author(s):  
Md Amzad Hossain ◽  
Tahmina Akther ◽  
Md Amran Sarker ◽  
Arunava Paul ◽  
Tanzina Zannat ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
Early Recognition ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Organ Damage ◽  
Clinical Syndrome ◽  
Laboratory Findings ◽  
Delay In Diagnosis ◽  
Clinical Presentations ◽  
Clinical Conditions

Haemophogocyticlymphohistiocytosis (HLH) is a rare but potentially fatal disease, which describes a clinical syndrome of hyper-inflammation resulting in uncontrolled and ineffective immune response. It appears commonly in infancy, although it has been seen in all age groups. A vast majority of cases are acquired due to secondary causes (infections, autoimmune, malignancy, metabolic disorders) but primary HLH (genetic) is also not uncommon which also gets triggered by infection as suggested by recent studies. “Hypercytokinemia” which is the hallmark of HLH can result in end organ damage and even death in some cases if there is delay in diagnosis. The pathological hallmark of this syndrome is uncontrolled activation of T lymphocytes and macrophages, together with an impaired cytotoxic function of NK cells and CD8+T lymphocytes resulting into massive cytokine release (e.g. interferon-ã, TNF-á, Interleukin-6, 8, 10, 12, 18) from this cells and overwhelming inflammation. Lymphocytes and macrophages sometimes with haemophagocytic activity accumulate in bone marrow, spleen, liver or lymph nodes. This disorder is characterized by fever, hepatosplenomegaly, lymphadenopathy, skin rash, cytopenias, hepatitis, coagulopathy, and neurological symptoms. We report a case of 55 yr. old male presenting with fever and high colored urine who developed clinical and laboratory findings consistent with diagnosis of HLH according to HLH-2004 guidelines. Unfortunately the patient died despite receiving chemotherapy. HLH has multifaceted clinical presentations with often non-specific signs and symptoms that are often found in other clinical conditions. Early recognition of HLH is critical in initiating therapy early and preventing high mortality resulting from multi-organ failure.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 51-58

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