Neuroleptic malignant syndrome. Diagnostic and therapeutic dilemmas in a general hospital setting

Neuroleptic malignant syndrome [NMS] is a rare life-threatening condition, usually induced by typical and atypical antipsychotics. A middle-aged woman with bipolar disorder and acute back pain due to multiple falls was admitted to the trauma ward of a general hospital. After 3 days, she suddenly developed signs and symptoms of NMS possibly caused by PRN injectable haloperidol, although the additional role of olanzapine could not be ruled out. A 3-day delayed diagnosis of NMS led to serious complications, which could be prevented by its prompt management contingent on its early diagnosis, even in the absence of certain diagnostic criteria. Although she improved substantially with treatment interventions and continued to have dialysis, she died later due to renal complications. The PRN administration of antipsychotic medications needs to be avoided among such psychiatric patients admitted to general hospitals

[Neuroleptic malignant syndrome: predisposing factors, symptomatoly, treatments and complications]

Neuroleptic Malignant Syndrome [NMS] is an acute and dangerous syndrome which usually arise as a side-effect of Neuroleptic drugs. Its high mortality rate, acute course and the current controversies about the best treatment method indicates the necessity of further investigation on its clinical features, predisposing factors and effective therapeutic methods. Retrospectively in a 4-year period, we studied patients hospitalized with NMS applying a 7-section questionnaire assessing: drug historys, the underlying psychiatric disorder, clinical signs and symptoms, laboratory findings, treatment methods and their outcomes, and duration of hospital stay. Rigidity and impaired consciousness were the most common clinical findings. Haloperidol, perphenazine and risperidone were the most common antisychotics used before the NMS onset. Mood disorders, schizophrenia, and mental retardation were the most frequent underlying disorders. The most common prescriptions for treatment of NMS were bromocriptine, fluid and electrolytes therapy, and amantadine. In diagnosing the NMS, impaired consciousness, especially when being accompanied by rigidity and fever, may be a more sensitive criteria than it is currently believed. Bromocriptin and fluid and electrolyte replacement therapy among many other treatment methods, and also interventions for prevention of NMS complications may play important roles in reducing its mortality rate

Neuroleptic malignant syndrome: need for early diagnosis and therapy

Neuroleptic Malignant Syndrome [NMS] is a medical entity that has received little attention in the clinical settings in Pakistan. The aim of our study was to review the predisposing factors, outcomes and characteristics of in-patients diagnosed with NMS. We performed a retrospective chart review of all cases [age > 15 years] at a tertiary care center in Karachi between January 01, 1990 and November 30, 2001, diagnosed using ICD 10 coding. Data was collected using a standardized data entry form and statistical analysis was performed using Epi Info 6, Version 6.02. There were a total of 20 patients diagnosed with NMS [11 male and 9 female] in our study with a mean age of 46.6 +/- 15.9 years. Haloperidol was the most frequently responsible neuroleptic. Of the 18 patients on a neuroleptic, most developed NMS after 8 weeks of therapy. There were 5 mortalities all of which were associated with septic shock. Fourteen patients recovered completely from the episode and did not have any neurologic sequelae. NMS is an important preventable clinical entity. Early diagnosis and judicious use of antipsychotics is warranted to prevent mortality and heightened morbidity

Síndrome neuroléptico maligno / Neuroleptic malignant syndrome

El Síndrome Neuroléptico Maligno es una enfermedad rara pero con alta mortalidad, por lo cual es conveniente tenerla presente ante la aparición de un cuadro de hipertermia inducido por drogas. En ocasiones la presentación clínica suele ser indistinguible de una Hipertermia Maligna, si bien su mecanismo fisiopatológico es completamente diferente. Sus características clínicas comprenden hipertermia, rigidez muscular, elevación de la creatininfosfoquinasa (C.P.K.) además de mioglobinemia y mioglobinuria, como consecuencia de la rabdomiólisis. En esta recopilación mencionaremos su fisiopatología, etiología, criterios clínicos, su relación con Hipertermia maligna y los detalles de su tratamiento.

Síndrome neuroléptico maligno: revisión / Neuroleptic malignant syndrome: review

El síndrome neuroléptico maligno, descrito en 1968 ha cobrado importancia dado el amplio uso de los neurolépticos en la ctualidad. Su reconocimiento precoz y manejo adecuado contribuyen a disminuir las complicaciones potencialmente letales del cuadro. En este trabajo realizamos una revisión de la literatura de los últimos años poniendo especial énfasis en aquellos aspectos relacionados con definición del cuadro clínico, complicaciones, factores predisponentes y de riesgo, tratamiento y manejo posterior. Con respecto al tratamiento y manejo posterior no se encuentran estudios prospectivos bien diseñados que avalen una conducta determinada, de manera que nos limitamos a sugerir aquellas maniobras de mayor consenso. Finalmente, se plantea la posibilidad de considerar al Síndrome Neuroléptico Maligno como parte del espectro común de reacciones del sistema nervioso frente a noxas diversas. Se hace evidente la necesidad de mayor investigación en este campo

Síndrome neuroléptico maligno: aspectos clínicos, diagnósticos y terapéuticos / Neuroleptic malignant syndrome: clinical, diagnostic and therapeutic aspects

El sindrome neuroleptico maligno (SNM) es semiologicamente una catatonfa aguda hipertermica haciendo un camino inverso, un sindrome catatonico agudo (SCA) puede ser endogeno, exogeno o reactivo. El SNM es una forma exogena. De 30 pacientes portadores de un SCA, en 12 pudo estabelecerse como almatente probable la presencia de un SNM. El tratamiento electroconvulsivante (TEC) demonstro ser un efectivo y contundente tratamiento para esta complicacion.

Sindrome neuroleptico maligno / Neuroleptic malignant syndrome

El sindrome neuroleptico maligno (SNM) es una complicacion rara, idiosincratica y potenciamente fatal, relacionanda con el uso de drogas que afectan el sistema dopaminergico; su cuadro clinico consiste en sintomas extrapiramidales, signos de disfuncion autonomica y trastornos en el estado de conciencia, asociados a leucocitosis y a cifras muy elevadas de creatinina fosioquinasa. Reportamos el caso de un hombre de 32 anos que preesento un sindrome catatonico severo despues del uso intrahospitalario de antipsicoticos potentes a altas dosis para el control de una depresion psicotica. Se discuten las caracteristicas clinicas del paciente y los hallazgos comunes en el SNM

The Neuroleptic Malignant Syndrome (NMS) Is a rare, idiosyncratic and potentially fatal complication of therapy with many drugs affecting the dopaminergic system; It Includes extrapyramidal symptoms, signs of autonomic dysfunction, disorders of consciousness, leucocytosis and an increase in serum creatine phosphokinase .We report the case of a 32 years old man, who developed a severe catatonic syndrome after receiving high doses of potent neuroleptics to control a psychotic depression. Clinical features of this case and common findings of NMS are discussed