[Neuroleptic Malignant Syndrome]

Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening neurological emergency, most commonly associated with antipsychotic drugs and other dopamine receptor-blocking agents. Although its incidence has declined over recent decades, NMS remains a diagnostic challenge due to its heterogeneous clinical presentation and overlap with other drug-induced syndromes. The classic clinical picture is defined by a tetrad of hyperthermia, generalized muscle rigidity, altered mental status, and autonomic dysfunction, frequently accompanied by marked creatine kinase elevation secondary to rhabdomyolysis. Diagnosis is primarily clinical and supported by complementary studies aimed at assessing severity, excluding differential diagnoses, and monitoring systemic complications. The underlying pathophysiology involves dopamine D2 receptor blockade within the central nervous system, particularly in the hypothalamus and basal ganglia, leading to impaired thermoregulation and motor control. Management relies on immediate discontinuation of the offending agent, intensive supportive care, and, in moderate to severe cases, pharmacological treatment with benzodiazepines, dopaminergic agents such as bromocriptine or amantadine, and muscle relaxants such as dantrolene. Early recognition and timely treatment are crucial to ensure favorable outcomes and reduce morbidity and mortality.