Case Report

Diagnostic, Treatment, and System Challenges in the Management of Recurrent Neuroleptic Malignant Syndrome on a General Medical Service

Table 1

Differential diagnosis.

ā€‰NMSMalignant CatatoniaNeuroleptic-induced ParkinsonismDelirium

Key featuresAutonomic Instability,
Delirium, Fever,
Rigidity; Precipitated by use of an antipsychotic
Autonomic
Instability,
Delirium, Fever, Rigidity
Postural and resting tremors, Rigidity (Cogwheel), Oral-buccal dyskinesias
(concurrent)
Waxing and waning consciousness,
Inattention, Perceptual deficits, Behavioral disorganization

Notable Lab ValuesElevated serum CK, leukocytosis, electrolyte
abnormalities, low serum
iron
Typically normalTypically normalDependent on etiology

TreatmentDantrolene,
Bromocriptine,
Benzodiazepines, NMDA antagonists, ECT
Benzodiazepines,
ECT, NMDA antagonists
Stopping the offending agent; if
not, Anticholinergics,
Amantadine
Typically antipsychotics;
benzodiazepines for
GABAergic
withdrawal or status epilepticus