PDF(Pubmed)
Abstract：
Neuroleptic malignant syndrome (NMS) is a severe reaction to antipsychotic medications characterized by fever, muscle rigidity, altered mental status, and autonomic dysfunction. Here, we describe the case of a 58-year-old female who presented with altered mental status two days after open reduction and internal fixation of the hip. A rapid response team was called when the patient appeared agitated with increased respiratory demand. After being intubated and moved to the ICU, she became febrile and rigid. A preliminary diagnosis of metabolic encephalopathy of unknown origin was made. Before being transported to the ICU, the patient was given multiple haloperidol doses in addition to her continued at-home medication, paroxetine, for major depressive disorder. The differential diagnosis included a workup for NMS, serotonin syndrome, and infectious processes. Once NMS was determined as the most likely etiology, all antipsychotic and serotonergic medications were discontinued. Then dantrolene and amantadine were administered, which resulted in clinically significant improvement. This case report demonstrates the importance of early identification of and intervention for NMS.
摘要：
抗精神病药物恶性综合征（NMS）是一种以发热为特征的抗精神病药物的严重反应，肌肉僵硬，精神状态改变,和自主神经功能障碍。这里,我们描述了一例58岁女性患者,在切开复位和髋部内固定术后2天出现精神状态改变.当患者出现呼吸需求增加的躁动时，召集了一个快速反应小组。插管并转移到ICU后，她变得发热和僵硬。初步诊断为不明原因的代谢性脑病。在被运送到ICU之前，患者除了继续在家服药外，还接受了多次氟哌啶醇剂量，帕罗西汀,重度抑郁症。鉴别诊断包括NMS检查，血清素综合征,和感染过程。一旦NMS被确定为最可能的病因，所有抗精神病药和5-羟色胺能药物均停用.然后服用丹曲林和金刚烷胺，这导致了临床上的显着改善。此病例报告证明了早期识别和干预NMS的重要性。
