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[Neuroleptic malignant syndrome. A case report]

A Guadagnucci1, D Tornaboni, G Vignali

  • 1U.O. Anestesia e Rianimazione, Ospedale SS. Giacomo e Cristoforo-Massa.

Minerva Medica
|July 1, 1995
PubMed
Summary

Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening reaction to antipsychotic medications. This case highlights a fatal NMS event in a bipolar disorder patient treated with haloperidol, emphasizing the critical need for vigilant monitoring and prompt intervention.

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Area of Science:

  • Pharmacology and Toxicology
  • Neuroscience
  • Critical Care Medicine

Background:

  • A 42-year-old woman with bipolar disorder experienced a relapse requiring increased haloperidol dosage and perphenazine administration.
  • The patient's medical history included multiple psychiatric hospitalizations.
  • The relapse occurred during a period of extreme heat, potentially exacerbating physiological stress.

Observation:

  • Initial symptoms included hallucinations and abdominal pain, with elevated CPK and urea.
  • The patient developed coma, hyperthermia, diaphoresis, polyuria, leukocytosis, and severe electrolyte imbalances (hyponatremia, hypokalemia), initially suggesting water intoxication.
  • Despite initial improvement, recurrence of hyperthermia, torpor, coma, muscular rigidity, and myoclonus indicated a severe adverse drug reaction.

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Findings:

  • Rapidly escalating creatine phosphokinase (CPK) and serum myoglobin levels indicated severe muscle breakdown (rhabdomyolysis).
  • The patient experienced multi-organ failure, including renal, cardiac, and respiratory insufficiency.
  • Autopsy revealed widespread rhabdomyolysis, shock, and acute tubular necrosis secondary to myoglobinuria.

Implications:

  • This case underscores the potentially fatal neuroleptic malignant syndrome (NMS) associated with antipsychotic use, particularly haloperidol.
  • The findings emphasize the importance of early recognition, differential diagnosis (including water intoxication), and aggressive management of NMS.
  • Vigilant monitoring for NMS symptoms is crucial, especially in patients with predisposing factors like psychiatric illness and exposure to high environmental temperatures.