Malignant hyperthermia and neuroleptic malignant syndrome, two hyperthermic syndromes, are discussed with respect to their pathogenesis, pathophysiological factors, diagnosis, differential diagnosis, and treatment. Malignant hyperthermia is a drug- or stress-induced hypermetabolic syndrome characterized by vigorous muscular contractures and cardiovascular collapse. Neuroleptic malignant syndrome results primarily from an imbalance of central neurotransmitters caused by neuroleptic drug use and characterized by mental status changes and muscular rigidity. Recognition and prompt treatment of these disorders reduces their morbidity and mortality.
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References
1.
Curley FJ, Irwin RS: Disorders of temperature control: Hyperthermia, Part 1J Intensive Care Med1986;1:5-14
2.
Slovis CM, Anderson GF, Casolaro A.: Survival in a heat stroke victim with a core temperature in excess of 46.5°C . Ann Emerg Med1982;11:269-271
3.
Aldrete JA: Advances in the diagnosis and treatment of malignant hyperthermia . Acta Anaesthesiol Scand1981;25:477-483
Denborough MA : Etiology and pathophysiology of malignant hyperthermia . Int Anesthesiol Clin1979;17:11-24
6.
Schiller HH: Chronic viral myopathy and malignant hyperthermia. N Engl J Med1975;292:1409
7.
Tsueda K., Dubick MN, Wright BD, et al: Intraoperative hyperthermic crisis in two children with undifferentiated lymphoma. Anesth Analg1978;57:511-514
8.
Kalow W., Britt BA, Chan F-Y.: Epidemiology and inheritance of malignant hyperthermia. Int Anesthesiol Clin1979;17:119-140
9.
Lutsky I., Witkowski J., Henschel EO: HLA typing in a family prone to malignant hyperthermia. Anesthesiology1982;56:224-226
10.
Britt BA: Preanesthetic diagnosis of malignant hyperthermia. Int Anesthesiol Clin1979;17:63-96
11.
Harriman DGF : Preanesthetic investigations of malignant hypothermia: Microscopy. Int Anesthesiol Clin1979;17:97-118
12.
Campbell IT , Ellis FR, Evans RT, Mortimer MG: Studies of body temperatures, blood lactate, cortisol and free fatty acid levels during exercise in human subjects susceptible to malignant hyperpyrexia. Acta Anaesthesiol Scand1983;27:349-355
13.
Britt BA, Kalow W.: Malignant hyperthermia: a statistical review. Can Anaesth Soc J1970;17:293-315
14.
Felice-Johnson J., Sudds T., Bennett G.: Malignant hyperthermia: Current perspectives . Am J Hosp Pharm1981 ;38:646-651
15.
Baudendistel L., Goudsouzian N., Cote C., Strafford M.: End tidal CO2 monitoring—its use in the diagnosis and management of malignant hyperthermia. Anaesthesia1984;39:1000-1003
16.
Liebenschutz F., Mai C., Pickerodt VWA: Increased carbon dioxide production in two patients with malignant hyperpyrexia and its control by dantrolene. Br J Anaesth1979;51:899-903
17.
Triner L., Sherman J.: Potential value of expiratory carbon dioxide measurement in patients considered to be susceptible to malignant hyperthermia. Anesthesiology1981;55:482
18.
Badgwell JM , Heaver JE: Masseter spasm heralds malignant hyperthermia or merely academia gone mad? Anesthesiology1984;61:230-231
19.
Schwartz L. , Rockoff MA, Koka BV: Masseter spasm with anesthesia: Incidence and implications. Anesthesiology1984;61:772-775
20.
Flewellen E. , Nelson TE: Halothane-succinylcholine induced masseter spasm: Indicative of malignant hyperthermia susceptibility? Anesth Analg1984;63: 693-697
Gallant EM, Ahern CP: Malignant hyperthermia: Responses of skeletal muscles to general anesthetics . Mayo Clin Proc1983;58:758-763
24.
Kolb ME, Home ML, Martz R.: Dantrolene in human malignant hyperthermia: A multicenter study. Anesthesiology1982;56:254-262
25.
Gjessing J. , Barsa J., Tomlin PJ: A possible means of rapid cooling in the emergency treatment of malignant hyperpyrexia. Br J Anaesth1976;48:469-473
26.
Ryan JF, Donlon JV, Malt RA, et al: Cardiopulmonary bypass in the treatment of malignant hyperthermia . N Engl J Med1974;290:1121-1122
27.
Delay J., Deniker P.: Drug-induced extrapyramidal syndromes. In: Vinken PJ, Bruyn GW, eds. Diseases of the basal ganglia. Amsterdam: North Holland Publishing, 1968:248-266
28.
Caroff SN: The neuroleptic malignant syndrome. J Clin Psychiatry1980;41:79-83
29.
Burke RE, Fahn S., Mayeaux R., et al: Neuroleptic malignant syndrome caused by dopamine-depleting drugs in a patient with Huntington's disease. Neurology ( NY) 1981;31:1022
30.
Itoh H., Ohtsuka N., Ogita K., et al: Malignant neuroleptic syndrome—its present status in Japan and clinical problems. Folia Psychiatr Neurol Jpn1977;31:565-576
31.
Stoudemire A., Luther JS: Neuroleptic malignant syndrome and neuroleptic induced catatonia: Differential diagnosis and treatment. Int J Psychiatry Med1984;14:57-63
32.
Oppenheim G. : Mutism and hyperthermia in a patient treated with neuroleptics. Med J Aust1973;2:228-229
33.
Eiser AR, Neff MS, Slifkin RF: Acute myoglobinuric renal failure a consequence of the neuroleptic malignant syndrome. Arch Intern Med1982;142:601-603
34.
Geller B., Greydanus DE: Haloperidol induced comatose state with hyperthermia and rigidity in adolescence: Two case reports with a literature review. J Clin Psychiatry1979;40:102-103
35.
Jesse SS, Anderson GF: ECT in the neuroleptic malignant syndrome: Case report. J Clin Psychiatry1983; 44:186-188
36.
Eles GR, Songer JE, DiPette DJ: Neuroleptic malignant syndrome complicated by disseminated intravascular coagulation . Arch Intern Med1984;144:1296-1297
37.
Liskow BI: Relationship between neuroleptic malignant syndrome and malignant hyperthermia . Am J Psychiatry1985;142:390
May DC, Moms SW, Stewart RM, et al: Neuroleptic malignant syndrome: Response to dantrolene sodium . Ann Intern Med1983;98:183-184
40.
Coons DJ, Hillman FJ, Marshall RW: Treatment of neuroleptic malignant syndrome with dantrolene sodium: A case report. Am J Psychiatry1982;139: 944-945
41.
Feibel JM, Schiffer RB: Sympathoadrenal medullary hyperactivity in the neuroleptic malignant syndrome: A case report. Am J Psychiatry1981 ;138:1115-1116
42.
Dhib-Jalbut S., Messelbrock R., Brott T., et al: Treatment of the neuroleptic malignant syndrome with bromocriptine. JAMA1983;250:484-485
43.
Amdurski S. , Radwan M., Levi A., et al: A therapeutic trial of amantadine in haloperidol-induced malignant neuroleptic syndrome . Curr Ther Res1983;33:225-229
44.
Goulon M., deRohan-Chabot P., Elkharrat D., et al: Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: A report of two cases. Neurology ( Cleveland) 1983;33:516-518
45.
Tollefson GD , Garvey MJ: The neuroleptic syndrome and central dopamine metabolites. J Clin Psychopharmacol1984;4:150
46.
Denborough MA, Collins SP, Hopkinson KC: Rhabdomyolysis and malignant hyperpyrexia . Br Med J1984;288:1878
47.
Goekoop JG, Carboat PA: Treatment of neuroleptic malignant syndrome with dantrolene. Lancet1982; 2:49-50
48.
Bernstein RA : Malignant neuroleptic syndrome: An atypical case. Psychosomatics1979;20:844-846
49.
Meltzer HY: Rigidity, hyperpyrexia and coma following fluphenazine enanthate. Psychopharmacologica (Berlin) 1973;29:337-346
50.
McCarron MM , Boettger ML, Peck JJ: A case of neuroleptic malignant syndrome successfully treated with amantadine. J Clin Psychiatry1982;43:381-382
51.
Granato JE, Stem BJ, Ringel A., et al: Neuroleptic malignant syndrome: Successful treatment with dantrolene and bromocriptine. Ann Neurol1983;14:89-90
52.
Zubenko G., Pope MG: Management of a case of neuroleptic malignant syndrome with bromocriptine . Am J Psychiatry1983;140:1619-1620
53.
Lotstra F., Linkowski P., Mendlewicz J.: General anesthesia after neuroleptic malignant syndrome. Biol Psychiatry1983;18:243-247
Lew T., Tollefson G.: Chlorpromazine-induced neuroleptic malignant syndrome and its response to diazepam. Biol Psychiatry1983;18:1441-1446
57.
Downey GP, Rosenberg M., Caroff S., et al: Neuroleptic malignant syndrome patient with unique clinical and physiologic features. Am J Med1984;77:338-340
58.
McAllister RG: Fever, tachycardia and hypertension with acute catatonic schizophrenia. Arch Intern Med1978;138:1154-1156
Henderson VW , Wooten GF: Neuroleptic malignant syndrome: a pathogenetic role for dopamine receptor blockade? Neurology ( NY) 1981;31:132-137
63.
Sechi GP, Tanda F., Mutani R.: Fatal hyperpyrexia after withdrawal of levodopa. Neurology1984;34:249-251
64.
Toru M., Matsuda O., Makiguchi K., et al: Neuroleptic malignant syndrome-like state following withdrawal of anti-parkinsonian drugs. J Nerv Ment Dis1981; 1969:324-327
65.
Powers P., Douglass TS, Waziri R.: Hyperpyrexia in catatonic states. Dis Nerv Sys1976;37:359-361
66.
Tandberg D. , Sklar D.: Effect of tachypnea on the estimation of body temperature by an oral thermometer. N Engl J Med1983;308:945-946
