Neuroleptic malignant syndrome

Question 1

Causative agents?

Answer 1

antipsychotic medications ( ex: haloperidol).
antiemetic medications ( ex: promethazine).
withdrawal of Parkinson medications.

Question 2

Pathophysiology?

Answer 2

central dopaminergic receptor blockade ( hyperthermia, dysautonomia).
disruption of nigrostriatal dopamine pathway ( rigidity).

Question 3

Signs and symptoms?

Answer 3

Fever, altered mental status, generalized muscle rigidity ( lead- pipe rigidity), autonomic instability ( abnormal vital signs, diaphoresis), elevated creatine kinase with or without renal failure.

Question 4

treatment?

Answer 4

stop antipsychotics or restart dopamine agents.
supportive care ( hydration, cooling), ICU, benzodiazepine, bromocriptine or dantrolene if refractory.