What is Neuroleptic malignant syndrome?

a rare but life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication

What is the common presentation of Neuroleptic malignant syndrome?

It occurs within hours to days of starting an antipsychotic:

• pyrexia
• muscle rigidity
• autonomic lability: typical features include hypertension, tachycardia and tachypnoea
• agitated delirium with confusion

What are the investigations findings in Neuroleptic malignant syndrome?

• Raised CK
• AKI can be seen in severe cases
• leukocytosis may be seen

What is the management of Neuroleptic malignant syndrome?

• stop antipsychotic
• IV fluids to prevent renal failure
• dantrolene may be useful in selected cases
  • thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
• bromocriptine, dopamine agonist, may also be used

What is the pathophysiology of Neuroleptic malignant syndrome?

pathophysiology is unknown but one theory is that the dopamine blockade induced by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage

What is the prognosis of Neuroleptic malignant syndrome?

mortality of up to 10%