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Neuroleptic malignant syndrome: two cases without muscle rigidity
1Department of Psychiatry, Queen Mary Hospital, Pokfulam, Hong Kong.
Objective:
Two patients with neuroleptic malignant syndrome without muscle rigidity are described.
Clinical Picture:
Both patients developed fever and altered consciousness while taking neuroleptic but did not develop muscle rigidity; the symptoms subsided when the neuroleptic was stopped but recurred when it was given again.
Treatment:
The neuroleptic was stopped; one patient received supportive treatment and the other received bromocriptine.
Outcome:
One patient died while the other survived.
Conclusion:
The pathophysiology is proposed as a combination of involvement of the central thermoregulatory, neuroregulatory and autonomic nervous systems, and the peripheral skeletal muscle. It supports the concept of a spectrum of clinical severity of neuroleptic malignant syndrome.