PDF(Pubmed)
Abstract：
Malignant syndrome (MS) in Parkinson\'s disease (PD) is a rare complication that occurs in patients who have a history of PD and are taking dopaminergic drugs. The syndrome is quite similar to neuroleptic malignant syndrome (NMS) in presentation and is a potentially fatal syndrome. Awareness of symptoms, early diagnosis, and the ability to differentiate it from NMS is important to prevent mortality. Clinical manifestations of MS are similar to NMS and include altered mentation, rigidity, fever, leukocytosis, and elevated serum creatine kinase (CK). However, MS is differentiated from NMS by the precipitating factors; of which, the commonest precipitating factor for MS is dopaminergic drug withdrawal or dose reduction while other less common causes include infection, dehydration, and hot weather. We present a rare case of MS in a patient with a history of PD precipitated by severe dehydration and hot weather in the absence of dopaminergic drug withdrawal. He presented with fever, severe rigidity, altered mentation, dehydration, leukocytosis, and elevated CK. He was correctly diagnosed with MS and promptly treated, preventing mortality. The triad of fever, severe rigidity, and altered sensorium in a patient with a history of PD should prompt evaluation for MS in addition to NMS to initiate appropriate treatment and prevent mortality.
摘要：
帕金森病（PD）中的恶性综合征（MS）是一种罕见的并发症，发生在有PD病史并正在服用多巴胺能药物的患者中。该综合征在表现上与抗精神病药恶性综合征（NMS）非常相似，是一种潜在的致命综合征。意识到症状，早期诊断,并且将其与NMS区分开来的能力对于预防死亡很重要。MS的临床表现与NMS相似，包括变异，刚性,发烧,白细胞增多,血清肌酸激酶（CK）升高。然而,MS与NMS的区别在于沉淀因素；其中，MS最常见的诱发因素是多巴胺能药物停药或剂量减少，而其他不太常见的原因包括感染，脱水,和炎热的天气。我们介绍了一例罕见的MS病例，该患者有PD病史，在没有多巴胺能药物戒断的情况下，由于严重脱水和炎热的天气而沉淀。他发烧了，严重的刚性,改变的心理状态，脱水,白细胞增多,升高CK。他被正确诊断为MS并得到及时治疗，预防死亡率。发烧的三合会，严重的刚性,有PD病史的患者的感觉中枢改变除了NMS外,还应提示MS的评估,以启动适当的治疗并预防死亡.
