Cerebral infarction in neuroleptic malignant syndrome

Two young women with no risk factors for cerebrovascular disease developed hyperpyrexia, rigidity, and autonomic features while taking neuroleptic agents. The first presented with increasing rigidity, profuse diaphoresis and dehydration, and a right hemiparesis, and computed tomography (CT) showed a left striato-capsular infarction. The second became unresponsive following severe hypoxia and was found to have left-sided pyramidal signs three days later. Hemoconcentration and hypoxemia predispose to cerebral ischemic injury in the neuroleptic malignant syndrome and should be avoided as much as possible.