The Clinical Presentation of Neuroleptic Malignant Syndrome

Abstract

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal syndrome occurring in patients receiving dopamine-receptor-blocking agents, including metoclopramide, prochlorperazine, and the antipsychotics. Symptoms include lead-pipe rigidity, fever, encephalopathy, autonomic dysfunction, tremor, and renal failure. Laboratory test results typically include elevated white blood cell counts, creatine phosphokinase levels, and liver enzyme levels. Patients taking high-potency, high-dose, or parenteral forms of antipsychotics, as well as those with concurrent medical conditions or a previous history of the syndrome, are at increased risk for NMS. Well-considered differential diagnosis and early recognition of NMS are critical. Treatment involves discontinuation of the inciting agent, supportive care, and possible administration of bromocriptine or dantrolene.