Hypermetabolic Syndrome and Dyskinesia After Neurologic Surgery for Labrune Syndrome: A Case Report

Abstract

A 20-year-old man with a rare neurodegenerative disease developed hypermetabolic symptoms with dyskinesia after a third ventriculostomy for hydrocephalus. The initial presentation was concerning for an acute dystonic reaction after metoclopramide was administered for nausea. He concurrently developed hypermetabolic symptoms, including hyperthermia, tachycardia, and a lactic acidosis. The diagnosis was broadened to include neuroleptic malignant syndrome, serotonin syndrome, and malignant hyperthermia. Although perhaps less intellectually satisfying but more true to clinical reality, we did not isolate a single diagnosis but treated effectively all 3 with dantrolene sodium and benzodiazepine.

Neuroleptic malignant syndrome in fields other than psychiatry

“…We performed a review of NMS case reports from clinicians other than psychiatrists in English and Japanese literature. They could be classified into two groups: (1) cases in which NMS onset was triggered by administering causative drugs 17–19,22–89 and (2) cases in which NMS developed from disruption of regular medication (Tables 7 and 8). 8,16,90–114 An example of the former is a case in which antipsychotic drugs were administered for postoperative delirium; an example of the latter is a case in which regular medication (i.e., antipsychotic drugs) to treat schizophrenia was discontinued temporarily because of general anesthesia.…”

“…The physical conditions of trauma patients were relatively severe compared with those with other diseases. The major reason for drug administration was postoperative restlessness, 18,19,25,27,28,[30][31][32][33][34][36][37][38][39]44,46,[52][53][54][55][57][58][59][61][62][63][64][67][68][69][70]72,75,78,81,84,86,89 followed by nausea 19,22,24,33,42,51,55,59,61,73,80,86 and delirium 35,…”

“…The physical conditions of trauma patients were relatively severe compared with those with other diseases. The major reason for drug administration was postoperative restlessness, 18,19,25,27,28,30–34,36–39,44,46,52–55,57–59,61–64,67–70,72,75,78,81,84,86,89 followed by nausea 19,22,24,33,42,51,55,59,61,73,80,86 and delirium 35,40,49,56,71,72,74,82,87,88 (Table 10). Haloperidol caused the highest number of NMS cases, 17–19,25–33,35–40,44,46,53–59,61–64,67,69,74–76,81,82,86,87,89 followed by metoclopramide, 19,24,42,55,60,73,77,86 quetiapine, 52,56,70–72 droperidol, 33,34,51,61 and risperidone 41,52,72,84 (Table 11).…”

“…The major reason for drug administration was postoperative restlessness, 18,19,25,27,28,30–34,36–39,44,46,52–55,57–59,61–64,67–70,72,75,78,81,84,86,89 followed by nausea 19,22,24,33,42,51,55,59,61,73,80,86 and delirium 35,40,49,56,71,72,74,82,87,88 (Table 10). Haloperidol caused the highest number of NMS cases, 17–19,25–33,35–40,44,46,53–59,61–64,67,69,74–76,81,82,86,87,89 followed by metoclopramide, 19,24,42,55,60,73,77,86 quetiapine, 52,56,70–72 droperidol, 33,34,51,61 and risperidone 41,52,72,84 (Table 11). Although the results indicated that haloperidol was the drug most commonly used to cure postoperative delirium, statistical analysis is needed to determine whether haloperidol is a significant cause of NMS.…”