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 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.

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

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.

Early recognition and critical management of adult epiglottitis in the emergency department: a case report and review of the literature

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Early Recognition ◽  
Pediatric Population ◽  
Delayed Diagnosis ◽  
Lateral Neck ◽  
Review Of The Literature ◽  
Acute Epiglottitis ◽  
Case Presentation ◽  
Life Threatening

Background: Acute epiglottitis was considered a disease of the pediatric population. However, it has constantly been a report of a certain number of adult cases. Death by airway obstruction is caused by delayed diagnosis and untimely invasive airway management contributing to the higher mortality rate in adults. Case presentation: We presented a case of a 24-year-old male patient without significant underlying condition, who presented at our emergency department with a progressive sore throat and high-graded fever for one day. After a set of investigations, the patient was diagnosed with acute epiglottitis, and airway management was managed accordingly. His conditions improved after a course of antibiotic treatment during hospital admission. Conclusion: Acute epiglottitis in adults is not frequently encountered in the emergency department. This case underlines the importance of clinical suspicions in cases with consistent symptoms as well as the excellent utility of lateral neck radiography for the diagnosis of this life-threatening entity.

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.

scholarly journals Lithium Toxicity and Neurologic Effects: Probable Neuroleptic Malignant Syndrome Resulting from Lithium Toxicity

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Osamede Edokpolo ◽  
Madiha Fyyaz
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Pharmacokinetic Interaction ◽  
Electrolyte Imbalance ◽  
Lithium Toxicity ◽  
Cerebral Infarcts ◽  
Lithium Level ◽  
Case Presentation ◽  
Gait Abnormality ◽  
Autonomic Instability ◽  
History Of

Introduction. We present the case of a patient who developed lithium toxicity with normal therapeutic levels, as a result of pharmacokinetic interaction with Valsartan, and probable Neuroleptic Malignant Syndrome from the ensuing lithium toxicity.Case Presentation. A 59-year old black male with bipolar disorder maintained on lithium and fluphenazine therapy presented with a 2 week history of worsening confusion, tremor, and gait abnormality. He recently had his dose of Valsartan increased. At presentation, patient had signs of autonomic instability, he was confused, dehydrated, and had rigidity of upper extremities. Significant labs on admission were lithium level-1.2, elevated CK-6008, leukocytosis WBC-22, and renal impairment; Creatinine-4.1, BUN-35, HCO3-20.1, and blood glucose 145. CT/MRI brain showed old cerebral infarcts, and there was no evidence of an infective process. Lithium and fluphenazine were discontinued, his lithium levels gradually decreased, and he improved with supportive treatment including rehydration and correction of electrolyte imbalance.Conclusions. This case illustrates that lithium toxicity can occur within therapeutic levels, and the neurotoxic effect of lithium can include Neuroleptic Malignant Syndrome. Clinicians should be aware of the risk associated with drug interactions with lithium.

Management of Suspected Neuroleptic Malignant Syndrome

1995 ◽  
Vol 40 (9) ◽  
pp. 545-550 ◽  
Author(s):  
Vr Velamoor ◽  
Gn Swamy ◽  
Late-Rs Parmar ◽  
P Williamson ◽  
Sn Caroff
Keyword(s):  
Risk Factors ◽  
Neuroleptic Malignant Syndrome ◽  
Early Recognition ◽  
Case Reports ◽  
Differential Diagnoses ◽  
Rational Approach ◽  
Review Of The Literature ◽  
Drug Induced ◽  
Induced Hyperthermia ◽  
Treatment Data

Objective Neuroleptic Malignant Syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia. The objective of this paper is to provide data regarding early and suspected cases as well as offer guidelines for managing this condition. Knowledge of suspected cases will lead to early recognition and prompt management of this condition in the future. Method To address the gap in knowledge, we present 2 case reports of patients with early NMS-like symptoms. The case reports are followed by a brief review of the literature on differential diagnoses, risk factors, early signs and treatment data. Conclusions The most rational approach to treating NMS entails a hierarchy of interventions determined by the severity and progression of symptoms.

Descending Cervical-Sacral Pain after the Administration of Antivenom to the Scorpion Sting Poisoning: A Case Report

2020 ◽  
Vol 2 (2) ◽  
pp. 93-96
Author(s):  
Josué Saúl Almaraz Lira ◽  
Alfredo Luis Chávez Haro ◽  
Cristian Alfredo López López ◽  
Remedios del Pilar González Jiménez
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Case Report ◽  
Signs And Symptoms ◽  
Cervical Region ◽  
Scorpion Sting ◽  
Case Presentation ◽  
Sacral Region ◽  
Scorpion Stings

Introduction. Scorpion stings occur mainly in spring and summer, with an estimate of 1.2 million cases per year worldwide. About 300,000 poisonings occur within a year, primarily affecting children and adults older than 65 years. In 2019, Guanajuato (Mexico) ranked third in poisoning by scorpion sting with a total of 43,913 cases. The intoxication grades are three where the signs and symptoms are varied. There are two types of antivenom in the Mexican market, and we use Alacramyn® in our case. Case presentation. A 70-year-old female —with grade 1 scorpion sting poisoning, 30 minutes of evolution, with type 2 diabetes and high blood pressure— received two vials of antivenom according to current regulations. She presented transient vagal reaction and subsequent transient pain in the cervical region that radiates to the sacral region. At discharge, there are no data compatible with scorpion sting poisoning. Conclusions. Transient pain in the cervical region to the sacral region may be secondary to an anxiety crisis, hypersensitivity to IgG, or secondary reaction to administration in less time than recommended by the provider. The benefit was greater than the reactions that occurred.

Therapeutic efficacy of Kantakari Ghrita in Tamaka Shwasa

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Dhanesh Kannan ◽  
Ravindra Angadi ◽  
Krishnendu O. Nambiar
Keyword(s):  
Marked Improvement ◽  
Signs And Symptoms ◽  
Unique Property ◽  
Test Design ◽  
Once Daily ◽  
Respiratory Condition ◽  
Post Test ◽  
Clinical Practise ◽  
Single Blind

Background: Ghrta Kalpana has a major role in clinical practise, because of its unique property of Samskarasya Anuvartanam. Tamaka Shwasa a Pranavaha Srothovikara, may be correlated to Bronchial Asthma, where in remissions and exacerbations are the typical features. The management of this acute respiratory condition is the long quest in the medical fraternity of all types. Hence, the present study was aimed to evaluate the role of Shamana therapy in the form of Kantakari Ghrta3 in Tamaka Shwasa patients. Objectives: To evaluate the effect of Kantakari Ghrta in Tamaka Shwasa. Methods: A total number of 30 patients were administered with 24 mgs of ‘Kantakari Ghrta’ once daily in the morning on empty stomach with Ushna Jala as Anupana. It was a single blind study with pre and post-test design. The effect was assessed by standard scoring assessment criteria followed by statistical analyses. Results: There was marked improvement in signs and symptoms and all were statistically significant. .

Sign in / Sign up

Export Citation Format

Share Document