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Neuroleptic Malignant Syndrome

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  1. See Also
    1. Extrapyramidal Side Effect
  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. Antipsychotic agents (higher risk at higher dose)
    2. Dopaminergic agent withdrawal (e.g. Sinemet)
  5. Symptoms
    1. Diffuse muscle rigidity (at onset)
    2. Muscle Tremor
    3. Altered Level of Consciousness (agitation, Delirium)
    4. Autonomic Dysfunction
      1. High Fever
      2. Diaphoresis
      3. Hypertension
  6. Labs
    1. Creatine Phosphokinase (CPK)
      1. Increase related to muscle rigidity
    2. Arterial Blood Gas (ABG)
      1. May demonstrate Metabolic Acidosis
  7. Management
    1. Withdraw causative Antipsychotic medication immediately
    2. Consider intensive care unit admission
    3. Lower temperature
    4. Control Hypertension
    5. Supportive care

Neuroleptic Malignant Syndrome (C0027849)

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)
ConceptsDisease or Syndrome (T047)
ICD9333.92
MSHD009459
EnglishMalignant neuroleptic syndrome, NEUROLEPTIC MALGNT SYND, NEUROLEPTIC MALIGNANT SYNDROME, Neuroleptic malignant syndrome -RETIRED-, Neuroleptic Malignant Syndromes, NMS - Neuroleptic malignant syndrome
Spanishsindrome neuroleptico maligno, sindrome neuroleptico maligno - RETIRADO -
Parent ConceptsPhysical findings (C0311392), Disorders, General, Functional and NEC (C0549512), Other and unspecified extrapyramidal diseases and abnormal movement disorders (C0154678), Basal Ganglia Diseases (C0004782), Neurotoxicity Syndromes (C0235032), Extrapyramidal Disorders (C0015371), Medication-induced movement disorder (C0236834), Reason not stated concept (C1276325), Duplicate concept (C1274013)
SourcesCST, ICD9CM, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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