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Neuroleptic Malignant Syndrome

Aka: Neuroleptic Malignant Syndrome
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  1. See Also
    1. Antipsychotic
    2. Extrapyramidal Side Effect
    3. Serotonin Syndrome
  2. Definition
    1. Life-threatening reaction to Antipsychotic agents
    2. Presents with muscle rigidity and Tremor, Altered Level of Consciousness, Hypertension and fever
  3. Pathophysiology
    1. Decreased CNS levels of Dopamine
  4. Causes
    1. Dopaminergic agent withdrawal (e.g. Sinemet withdrawal)
    2. Dopamine receptor blockade
    3. Antipsychotic agents (higher risk at higher dose)
      1. Higher risk with higher potency first generation agents (although can occur with any Antipsychotic)
      2. Haloperidol (Haldol) or Haloperidol decanoate
      3. Perphenazine (Trilafon)
      4. Thiothixene HCl (Navane)
      5. Fluphenazine HCl (Prolixin)
      6. Trifluoperazine (Stelazine)
  5. Symptoms
    1. Diffuse muscle rigidity (at onset)
      1. "Lead pipe" rigidity
    2. Muscle Tremor
    3. Altered Level of Consciousness (agitation, Delirium)
    4. Bradykinesia and Bradyreflexia (contrast with Serotonin Syndrome)
    5. Autonomic Dysfunction
      1. High Fever
      2. Diaphoresis
      3. Hypertension
  6. Differntial Diagnosis
    1. Serotonin Syndrome
      1. In contrast to NMS, Serotonin Syndrome presents with hyperreflexia and motor restlessness
  7. Labs
    1. Creatine Phosphokinase (CPK)
      1. Increase related to muscle rigidity
    2. Arterial Blood Gas (ABG)
      1. May demonstrate Metabolic Acidosis
  8. Management
    1. Correct causative factors
      1. Withdraw causative Antipsychotic medication immediately
      2. If secondary to cessation of Dopaminergic agent (e.g. Sinemet), consider restarting the medication
    2. Intensive care unit admission
    3. Lower temperature (active cooling may be needed)
      1. See Heat Stroke for similar protocol
    4. Severe rigidity may require paralysis and intubation
    5. Control Hypertension
    6. Supportive care

Neuroleptic Malignant Syndrome (C0027849)

Definition (NCI) A life-threatening condition that may be caused by certain drugs used to treat mental illness, nausea, or vomiting. Symptoms include high fever, sweating, unstable blood pressure, confusion, and stiffness.
Definition (NCI) A rare, life-threatening disorder that is caused by neuroleptic medications. It is characterized by fever, muscular cramps and rigidity, autonomic nervous system dysfunction, and changes in the mental status that may lead to coma.
Definition (MSH) A potentially fatal syndrome associated primarily with the use of neuroleptic agents (see ANTIPSYCHOTIC AGENTS) which are in turn associated with dopaminergic receptor blockade (see RECEPTORS, DOPAMINE) in the BASAL GANGLIA and HYPOTHALAMUS, and sympathetic dysregulation. Clinical features include diffuse MUSCLE RIGIDITY; TREMOR; high FEVER; diaphoresis; labile blood pressure; cognitive dysfunction; and autonomic disturbances. Serum CPK level elevation and a leukocytosis may also be present. (From Adams et al., Principles of Neurology, 6th ed, p1199; Psychiatr Serv 1998 Sep;49(9):1163-72)
Concepts Disease or Syndrome (T047)
MSH D009459
ICD9 333.92
ICD10 G21.0
SnomedCT 68977009, 192826000, 15244003
DSM4 333.92
English Neuroleptic Malignant Syndrome, Neuroleptic Malignant Syndromes, Syndrome, Neuroleptic Malignant, Syndromes, Neuroleptic Malignant, NEUROLEPTIC MALIGNANT SYNDROME, neuroleptic malignant syndrome (diagnosis), neuroleptic malignant syndrome, Neuroleptic malignant, NMS (Neuroleptic Malignant Syndrome), Neuroleptic malgnt synd, Neuroleptic Malignant Syndrome [Disease/Finding], malignant neuroleptic, neuroleptic malignant, malignant neuroleptic syndrome, nms, NMS, NMSs (Neuroleptic Malignant Syndrome), Malignant neuroleptic syndrome, Neuroleptic malignant syndrome, Neuroleptic malignant syndrome (disorder), NMS - Neuroleptic malignant syndrome, malignant; neuroleptic syndrome, syndrome; malignant neuroleptic, Neuroleptic malignant syndrome -RETIRED-
Spanish SINDROME NEUROLEPTICO MALIGNO, SNM, Neuroleptic malignant syndrome, síndrome neuroléptico maligno (trastorno), síndrome neuroléptico maligno - RETIRADO - (concepto no activo), síndrome neuroléptico maligno - RETIRADO -, síndrome neuroléptico maligno, Síndrome neuroléptico maligno, Síndrome Neuroléptico Maligno, Sindrome Neuroleptico Maligno
Dutch neuroleptica maligne, maligne neurolepticasyndroom, maligne; neuroleptisch syndroom, syndroom; maligne neuroleptisch, neuroleptisch maligne syndroom, Maligne neuroleptisch syndroom, Neuroleptisch syndroom, maligne, Syndroom, neuroleptisch, maligne
French S. neuroleptique malin, SNM, SYNDROME MALIN DES NEUROLEPTIQUE, Syndrome malin des neuroleptiques, SMN (Syndrome Malin des Neuroleptiques)
German NMS, Malignes Neuroleptika-Syndrom, NEUROLEPTISCHES SYNDROM MALIGNE, malignes neuroleptisches Syndrom, Malignes neuroleptisches Syndrom
Italian Neurolettica maligna, Sindrome neurolettica maligna, Sindrome maligna da neurolettici (SMN), Sindrome maligna da neurolettici
Portuguese Síndrome maligna de neuroléptico, SINDROME NEUROLEPTICO MALIGNO, Síndrome neuroléptica maligna, Síndrome Maligna Neuroléptica
Swedish Neuroleptiskt malignt syndrom
Japanese ｱｸｾｲｼｮｳｺｳｸﾞﾝ, 神経遮断薬による悪性症候群, 神経弛緩薬性悪性症候群, 神経遮断薬悪性症候群, 神経遮断薬性悪性症候群, 悪性症候群
Czech neuroleptický maligní syndrom, NMS, Maligní neuroleptický syndrom, Neuroleptický maligní
Finnish Neuroleptioireyhtymä
Russian NEIROLEPTICHESKII ZLOKACHESTVENNYI SINDROM, НЕЙРОЛЕПТИЧЕСКИЙ ЗЛОКАЧЕСТВЕННЫЙ СИНДРОМ
Korean 악성 신경마비성 증후군
Polish Zespół neuroleptyczny złośliwy
Hungarian Neurolepticus malignus syndroma, Malignus neuroleptikus syndroma
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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