A Case Report on Neuroleptic Malignant Syndrome (NMS): How to Approach an Early Diagnosis

Paul, Tanya; Karam, Alvina; Paul, Trissa; Loh, Hanyou; Ferrer, Gerardo F

doi:10.7759/cureus.23695

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Another case of classic NMS was due to cocaine use that occurred in the absence of antipsychotic medications [ 16 ]. A third case reported NMS with muscular rigidity in the setting of antipsychotic use in a chronic cocaine user, who did not have any recent cocaine use [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Development of Atypical Neuroleptic Malignant Syndrome After Treatment of Cocaine Intoxication: A Case Report and Literature Review

Miller¹,

Zezetko²,

Satodiya³

2023

Cureus

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Neuroleptic malignant syndrome (NMS) is a life-threatening condition classically associated with the use of antipsychotic medications. NMS commonly presents with initial mental status changes, followed by muscle rigidity, fever, and eventual dysautonomia. Cocaine intoxication can present with symptoms that are very similar to those found in NMS, making differentiating the two disorders challenging. We present the case of a 28-year-old female with a history of cocaine use disorder who presented with acute cocaine intoxication. She had severe agitation associated with her intoxication, requiring the use of antipsychotic medications. Subsequently, she developed atypical NMS from abrupt dopamine withdrawal after receiving the antipsychotics. Although overlapping dopamine pathways between cocaine use and NMS could deter one from this practice and guidelines recommend against it, antipsychotics are routinely used in the emergency setting for cocaine-associated agitation. This case highlights the need for a more standardized treatment protocol, provides an explanation of why treating cocaine intoxication with antipsychotics is inappropriate, and suggests that chronic cocaine users may be more prone to NMS in this scenario. Furthermore, this is a unique case because it describes atypical NMS in the context of cocaine intoxication, chronic cocaine use, and administration of antipsychotics to an antipsychotic-naïve patient.

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Section: Discussionmentioning

confidence: 99%

Development of Atypical Neuroleptic Malignant Syndrome After Treatment of Cocaine Intoxication: A Case Report and Literature Review

Miller¹,

Zezetko²,

Satodiya³

2023

Cureus

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“…Typical laboratory findings include raised creatinine phosphokinase and leukocytosis. 1 The global incidence of patients taking neuroleptic drugs ranges from 0.01 to 3.2%. The majority of the cases are reported in young adults.…”

Section: Introductionmentioning

confidence: 99%

An afebrile neuroleptic malignant syndrome with hyponatremia: A case report.

Shoaib,

Arshad,

Ullah

et al. 2024

JSTMU

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Neuroleptic malignant syndrome (NMS) is a rare, life-threatening situation in response to the adverse reaction of antipsychotic medications characterized by high-grade fever, altered Glasgow coma scale, autonomic dysfunction, and stiffness. We herein present a case with a typical presentation of stiffness and autonomic dysregulations along with the atypical symptoms of urinary incontinence and a history of falls. The patient was afebrile with hyponatremia, showing a similar presentation diagnosed as NMS and treated successfully according to the hospital protocol.

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Neuroleptic Malignant Syndrome: An Unusual Case to Increase Clinical Attention

Seval

Phalswal

2022

IJAR

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A 26-year-young man was taken to the hospital with symptoms of schizophrenia, and treatment began with a high dose of antipsychotic medication. After receiving medication for 3–4 days, the patient experienced persistently high body temperatures, tight muscles, and raised blood levels of CK-MB and CK-NAC. The results of all other investigations were normal. A rare Neuroleptic Malignant Syndrome (NMS) was made and treatment started with immediate withdrawal of the causative drug, and timely supportive therapy led to a successful recovery. This case illustrates the importance of adopting a broad differential diagnosis for fever, carefully reviewing the prescription lists of all patients, and taking NMS into account in patients who have both fever and stiffness.

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A Case Report on Neuroleptic Malignant Syndrome (NMS): How to Approach an Early Diagnosis

Cited by 4 publications

References 6 publications

Development of Atypical Neuroleptic Malignant Syndrome After Treatment of Cocaine Intoxication: A Case Report and Literature Review

Development of Atypical Neuroleptic Malignant Syndrome After Treatment of Cocaine Intoxication: A Case Report and Literature Review

An afebrile neuroleptic malignant syndrome with hyponatremia: A case report.

Neuroleptic Malignant Syndrome: An Unusual Case to Increase Clinical Attention

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