On the Early Recognition of Neuroleptic Malignant Syndrome

1986 ◽  
Vol 15 (4) ◽  
pp. 299-310 ◽  
Author(s):  
Terri Clark ◽  
Jambur Ananth ◽  
Stephen Dubin
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Clinical Picture ◽  
Early Recognition ◽  
Neuroleptic Drug ◽  
Altered Consciousness ◽  
Fatal Complication ◽  
Laboratory Findings ◽  
Autonomic Instability ◽  
Elevated Creatinine

Neuroleptic Malignant Syndrome, a serious and sometimes fatal complication, has been reported to occur in some patients with the administration of neuroleptic medications. Clinically it is manifested by four groups of symptoms which include muscular hypertonicity, autonomic instability, altered consciousness, and hyperthermia. Laboratory findings such as elevated creatinine phosphokinase and leukocytosis are also seen. While it is true that the incidence of the full blown clinical picture of this syndrome is rare, the authors report that only muscular hypertonicity and autonomic instability have occurred frequently in their setting leading to discontinuation of neuroleptics. Such abortive cases may go undetected. If properly diagnosed, the occurrence of this syndrome is not as rare as the published reports indicate. Second, it is reported that rechallenge with neuroleptics may not induce Neuroleptic Malignant Syndrome again. The authors noted recurrence of fever after rechallenge with a different neuroleptic drug. This article describes the method of early recognition and prevention of morbidity as well as mortality.

An Iatrogenic Catatonia

2016 ◽  
Author(s):  
Robertus M. A. de Bie
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Creatine Phosphokinase ◽  
D2 Receptor ◽  
Disease Course ◽  
Atypical Neuroleptics ◽  
Altered Consciousness ◽  
Creatine Phosphokinase Level ◽  
Autonomic Instability ◽  
Increasing Temperature ◽  
Degrees Of Severity

Neuroleptic malignant syndrome is an iatrogenic movement disorders emergency characterized by rigidity, altered consciousness, and autonomic instability of varying degrees of severity. In severe cases this can be a fatal syndrome, so recognition and withdrawal of potentially causative medications is the priority. Management is otherwise supportive, and some patients will require admission to an intensive care unit. Creatine phosphokinase can be used to monitor the disease course; a decreasing creatine phosphokinase level with an increasing temperature may indicate an infection. The incidence of neuroleptic malignant syndrome has declined considerably with the increased use of atypical neuroleptics with greater D2 receptor blockade compared to older agents.

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.

Carbamazepine and Forme Fruste Neuroleptic Malignant Syndrome

1990 ◽  
Vol 157 (3) ◽  
pp. 437-438 ◽  
Author(s):  
Tim Dalkin ◽  
Alan S. Lee
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Altered Consciousness ◽  
Autonomic Instability

A woman developed rigidity, autonomic instability and altered consciousness after taking an overdose of trifluoperazine and carbamazepine. A diagnosis of NMS was made despite the absence of fever, as carbamazepine might modify the presentation of NMS.

Neuroleptic Malignant Syndrome: Two Cases without Muscle Rigidity

1996 ◽  
Vol 30 (3) ◽  
pp. 415-418 ◽  
Author(s):  
Michael M.C. Wong
Keyword(s):  
Skeletal Muscle ◽  
Neuroleptic Malignant Syndrome ◽  
Clinical Picture ◽  
The Other ◽  
Clinical Severity ◽  
Muscle Rigidity ◽  
Supportive Treatment ◽  
Altered Consciousness ◽  
Nervous Systems ◽  
Autonomic Nervous

Objective: Two patients with neuroleptic malignant syndrome without muscle rigidity are described. Clinical picture: Both patients developed fever and altered consciousness while taking neuroleptic but did not develop muscle rigidity; the symptoms subsided when the neuroleptic was stopped but recurred when it was given again. Treatment: The neuroleptic was stopped; one patient received supportive treatment and the other received bromocriptine. Outcome: One patient died while the other survived. Conclusion: The pathophysiology is proposed as a combination of involvement of the central thermoregulatory, neuroregulatory and autonomic nervous systems, and the peripheral skeletal muscle. It supports the concept of a spectrum of clinical severity of neuroleptic malignant syndrome.

scholarly journals Emergent Treatment of Neuroleptic Malignant Syndrome Induced by Antipsychotic Monotherapy Using Dantrolene

2019 ◽  
Vol 3 (1) ◽  
pp. 16-23
Author(s):  
Vivian Ngo ◽  
Alfredo Guerrero ◽  
David Lanum ◽  
Michelle Burgett-Moreno ◽  
Gregory Fenati ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Malignant Hyperthermia ◽  
Neuroleptic Malignant Syndrome ◽  
Neuroleptic Drug ◽  
Potential Treatment ◽  
Emergency Physicians ◽  
Off Label Use ◽  
Fatal Complication ◽  
Delay In Diagnosis ◽  
Off Label

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication resulting from neuroleptic drug therapy. Presentation of NMS can vary, and diagnosis relies primarily upon medical history and symptomatology. Due to the potential delay in diagnosis, emergency physicians should remain vigilant in recognizing the symptoms of NMS and be prepared to initiate immediate treatment following diagnosis. Dantrolene, which has been used for spasticity and malignant hyperthermia, has been reported as a potential treatment for NMS and led to off-label use for NMS. We report two cases of NMS induced by antipsychotic monotherapy for which dantrolene was administered.

scholarly journals Neuroleptic Malignant Syndrome or Catatonia? A Case Report

2020 ◽  
Vol 6 (3) ◽  
pp. 190-193
Author(s):  
Sebastian Rodriguez ◽  
Keith A. Dufendach ◽  
Robert M. Weinreib
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Marked Improvement ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Life Saving ◽  
Intravenous Diazepam ◽  
Autonomic Instability

AbstractIntroductionA review of the literature has shown that there are many similarities in the presentation of neuroleptic malignant syndrome (NMS) and catatonia. Attempts to reconcile the differences have been made by suggesting that NMS and catatonia may represent different presentations of the same illness or that they lie within the same spectrum of a poorly understood clinical syndrome. The described case is of a patient who presented with NMS and catatonia which was difficult to diagnose, but which responded to treatment with intravenous diazepam.Case presentationThe case concerns a 22-year-old male admitted for pulmonary hypertension to an intensive care unit (ICU). Three days following admission, he developed a high fever that did not respond to antibiotics. The patient then developed rigidity, nocturnal agitation, decreased responsiveness, and somnolence. Without the use of bromocriptine (Novartis, Basel, Switzerland) or dantrolene (Par Pharmaceuticals, Chestnut Ridge, USA) discontinuation of neuroleptics combined with intravenous diazepam (Pfizer, NY, USA) led to a very rapid response and marked improvement in the case.ConclusionsEarly recognition and management of NMS and MC in a complex, gravely ill patient, may be accomplished in the ICU despite obfuscation of traditional signs and symptoms of the NMS and MC syndrome. Such interventions can have life-saving effects on patients in danger of fatal autonomic instability.

scholarly journals Neuroleptic malignant syndrome due to risperidone misdiagnosed as status epilepticus

2011 ◽  
Vol 3 (3) ◽  
pp. 19 ◽  
Author(s):  
Ali Ertug Arslankoylu ◽  
Meryem Ozlem Kutuk ◽  
Cetin Okuyaz ◽  
Fevziye Toros
Keyword(s):  
Status Epilepticus ◽  
Emergency Room ◽  
Neuroleptic Malignant Syndrome ◽  
Neuroleptic Drug ◽  
High Dose ◽  
Muscle Rigidity ◽  
Neuroleptic Treatment ◽  
The Past ◽  
Autonomic Instability ◽  
Risperidone Treatment

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disease characterized by fever, muscle rigidity, delirium and autonomic instability. Here we report a child, with NMS due to the risperidone misdiagnosed as status epilepticus. Nine year old boy, who had been under high dose risperidone treatment for 8 weeks, admitted to the emergency room because of the contractions (evaluated as status epilepticus) persisting for 7 hours. Since there was neuroleptic treatment in the past medical history and, unconsciousness, muscular rigidity, diaphoresis, hypertermi and, hypotension in physical examination, leucocytosis and elevated creatininphosphokinase levels in laboratory tests, the patient was evaluated as NMS and discharged without any complications. We reported this case to point out that; NMS may be misdiagnosed as status epilepticus in children when EEG monitoring is unavailable. When a child admitted to the emergency room because of suspicious convulsion neuroleptic drug use must surely be asked.

scholarly journals Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

2012 ◽  
Vol 45 (2) ◽  
pp. 147-150 ◽  
Author(s):  
Guenael Freire de Souza ◽  
Fernando Biscione ◽  
Dirceu Bartolomeu Greco ◽  
Ana Rabello
Keyword(s):  
Hiv Infection ◽  
Clinical Response ◽  
Clinical Picture ◽  
Treatment Initiation ◽  
Early Recognition ◽  
Response To Treatment ◽  
Hiv Positive ◽  
Large Area ◽  
Belo Horizonte ◽  
Hiv Negative

INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.

scholarly journals Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion

2018 ◽  
Author(s):  
Quintí Foguet-Boreu ◽  
Montse Coll-Negre ◽  
Montse Serra-Millàs ◽  
Miquel Cavalleria-Verdaguer
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Electroconvulsive Therapy ◽  
Potential Role ◽  
Caucasian Woman ◽  
Concomitant Treatment ◽  
Pharmacological Treatments ◽  
Severe Motor ◽  
Autonomic Instability ◽  
History Of ◽  
Psychotic Features

Neuroleptic malignant syndrome (NMS) is a severe motor syndrome occurring as a consequence of neuroleptic treatment. We present a case of a 67-year-old Caucasian woman with a history of a major depressive disorder with psychotic features. During her third hospital admission, symptoms of autonomic instability, hyperpyrexia, severe extrapyramidal side effects, and delirium appeared, suggesting NMS due to concomitant treatment with risperidone and quetiapine, among other drugs. Despite several consecutive pharmacological treatments (lorazepam, bromocriptine and amantadine) and prompt initiation of electroconvulsive therapy (ECT), clinical improvement was observed only after combining bupropion with ECT. The symptoms that had motivated the admission gradually remitted and the patient was discharged home. Bupropion increases dopaminergic activity in both the nucleus accumbens and the prefrontal cortex. Therefore, from a physiopathological standpoint, bupropion has a potential role in treating NMS. However, there is scarce evidence supporting this approach and therefore future cases should be carefully considered.

scholarly journals Anca-associated crescentic glomerulonephritis in a child with isolated renal involvement

2019 ◽  
Vol 41 (2) ◽  
pp. 293-295
Author(s):  
Mehtap Ezel Çelakıl ◽  
Burcu Bozkaya Yücel ◽  
Umay Kiraz Özod ◽  
Kenan Bek
Keyword(s):  
Crescentic Glomerulonephritis ◽  
Renal Involvement ◽  
Immunosuppressive Treatment ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Normal Serum ◽  
Laboratory Findings ◽  
Elevated Creatinine ◽  
Systemic Symptoms ◽  
Mild Clinical Presentation ◽  
Normal Serum Creatinine

ABSTRACT Pauci-immune glomerulonephritis (GN) is more common in elderly people compared to children and the etiology is not completely understood yet. Antineutrophil cytoplasmic antibody (ANCA) positivity occurs in 80% of the patients. We report a case of a 7-year-old girl who presented with malaise and mildly elevated creatinine diagnosed as ANCA-associated pauci-immune crescentic glomerulonephritis with crescents in 20 of 25 glomeruli (80%). Of these 20 crescents, 12 were cellular, 4 fibrocellular, and 4 globally sclerotic. She did not have purpura, arthritis, or systemic symptoms and she responded well to initial immunosuppressive treatment despite relatively severe histopathology. The patient was given three pulses of intravenous methylprednisolone (30 mg/kg on alternate days) initially and continued with cyclophosphamide (CYC; 2 mg/kg per day) orally for 3 months with prednisone (1 mg/kg per day). In one month, remission was achieved with normal serum creatinine and prednisone was gradually tapered. The case of this child with a relatively rare pediatric disease emphasizes the importance of early and aggressive immunosuppressive treatment in patients with renal-limited ANCA-associated pauci-immune crescentic GN even if with a mild clinical presentation. As in our patient, clinical and laboratory findings might not always exactly reflect the severity of renal histopathology and thus kidney biopsy is mandatory in such children to guide the clinical management and predict prognosis.

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