[Polytrauma and malignant neuroleptic syndrome. Case presentation with diagnostic problems]

The neuroleptic malignant syndrome (NMS) is a rare but potentially fatal reaction associated with neuroleptic drugs. The role of an acute reduction in brain dopamine activity in the development of NMS is commonly accepted as underlying pathogenesis. The diagnosis is maintained by the classic findings of extrapyramidal signs, hyperthermia and autonomic dysfunction. Treatment consists primarily of early recognition and discontinuation of triggering drugs. We report on a young patient with an acute paranoid schizophrenia who suffered a severe polytrauma due to a jump from 10 m height initiated by acoustic hallucinations. The patient received haloperidol for psychotic symptoms in a dose of up to 65 mg/d and chlorprothixene. NMS developed during the second week after the polytrauma. Discontinuation of neuroleptic therapy was followed by complete recovery. The report underlines problems of diagnosis due to the ambiguity of the diagnostic criteria of neuroleptic malignant syndrome in the presence of polytrauma.