Haloperidol Induced Neurolept Malignant Syndrome Complicated by Right Ventricular Myocardial Infarction.

A fatal case of right ventricular myocardial infarction in the absence of risk factors, concurrent with haloperidol induced neuroleptic malignant syndrome, is presented; suggesting the existence of a causal relation between the two. Possible pathophysiological mechanisms have been discussed

[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

Simultaneous occurrence of toxic epidermal necrolysis and neuroleptic malignant syndrome.

Toxic epidermal necrolysis (TEN) is an acute life-threatening blistering disease characterized by involvement of the skin, multiple mucous membranes and internal organs. It is most commonly precipitated by the administration of medications like anticonvulsants. Neuroleptic malignant syndrome (NMS) is a rare complication of neuroleptic therapy characterized by catatonic behavior, generalized muscular rigidity, hyperthermia and autonomic dysfunction. An 18-year-old girl presenting with simultaneous appearance of TEN and NMS following anti-psychotic drugs given for bipolar mood disorder, is reported for the rare association and her complete recovery.

Neuroleptic-induced acute respiratory distress syndrome

CONTEXT: A case of neuroleptic malignant syndrome and acute respiratory distress syndrome is presented and discussed with emphasis on the role of muscle relaxation, creatine kinase, and respiratory function tests. CASE REPORT: A 41-year-old man presented right otalgia and peripheral facial paralysis. A computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. Preoperative examination revealed: pH 7.4, PaCO2 40 torr, PaO2 80 torr (room air), Hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. The chest x-ray was normal. The patient had not eaten during the 12-hour period prior to anesthesia induction. Intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. After the first six hours, the PaO2 was 65 torr (normal PaCO2) with FiO2 50 percent (PaO2/FiO2 130), and remained at this level until the end of the operation 4 hours later, maintaining PaCO2 at 35 torr. A thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. No vasospasm was present. This case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. Neuroleptic malignant syndrome is a disease that is difficult to diagnose. Acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. Some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. Intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome

Susceptibilidade à hipertermia maligna em três pacientes com síndrome maligna por neurolépticos / Malignant hyperthermia susceptibility in three patients with malignant neuroleptic syndrome

A hipertermia maligna caracteriza-se por hipertermia, rigidez muscular, rabdomiólise, acidose e insuficiência de múltiplos órgaos. A hipertermia maligna anestésica decorre da exposiçao a halogenados e/ou relaxantes musculares despolarizantes. O método padrao para diagnosticar a suscetibilidade à hipertermia maligna é o teste da contratura muscular in vitro em resposta ao halotano e à cafeína. A síndrome maligna por neurolépticos caracteriza-se por hipertermia, síndrome extrapiramidal, acidose, instabilidade neurovegetativa e alteraçoes neurológicas. Descrevemos três pacientes com síndrome maligna por neurolépticos e testes de contratura muscular positivos. Esse achado demonstra que ocasionalmente o músculo de pacientes com síndrome maligna por neurolépticos pode mostrar as alteraçoes encontradas na hipertermia maligna anestésica

Neuroleptic Malignant Syndrome: a comprehensive review and update

Objective; neuroleptic malignant syndrome [NMS] is a life-threatening psychomedical emergency arising as a complication of neuroleptic therapy. This paper critically reviews this syndrome update the data and also identifies the areas where knowledge is deficient. an extensive online search through the years 1974 to 1995 was made and several related books and relevant papers published in different peer-reviewed national and international journals were located. the presentation of NMS in developing countries is like that of the developed nations, however, the specific pharmacotherapy and the guidelines recommended there are sparingly used to treat this syndrome in developing world where there is dearth of data on this syndrome. Conclusions: comparatively NMS is coupled with high morbidity and mortality in developing nations as it often underdiagnosed and undertreated. From this perspective there is a crucial need to launch a NMS awareness campaign among medical community in rapidly developing countries, however, at international level multicenter studies are needed to clarify many different facets of this syndrome

Neuroleptic malignant syndrome among acute psychiatric admissions in Barbados

The main features of the Neuroleptic Malignant Syndrome (NMS), a complication of neuroleptic therapy, are fever, muscle rigidity, autonomic dysfunction, and an alteration in consciousness level. We describe five cases of NMS comprising 0.6 per cent of acute neuroleptically-treated admissions to a psychiatric hospital over a one-year period. All patients, four females aged 26 to 63 years, and one male, aged 65 years, were of African origin and received multiple neuroleptic drugs, at least one of which was a depot preparation. Four were being treated for functional psychiatric disorders while one had dementia. All patients had fever and depressed consciousness level while four had rigidity and autonomic dysfunction. Serum creatine phosphokinase was elevated in 4 cases, and there was indirect evidence of myoglobinuria in 3 cases suggested by a positive urine dipstick test for blood despite the absence of red cells on microscopy. Rhabdomyolysis was associated with renal failure in one case. Both bromocriptine mesylate and dantrolene sodium were given in two cases. Three patients died in hospital, one with persistent rigidity and progressive decubitus ulceration, one from peritonitis following dialysis, and another suddenly. Early recognition of NMS is important; it should be considered in any patient on neuroleptic therapy who develops fever, rigidity or alteration in consciousness level.