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Neuroleptic Malignant Syndrome
Symptoms and Signs of Neuroleptic Malignant Syndrome
Symptoms of neuroleptic malignant syndrome begin most often during the first 2 weeks of treatment with neuroleptic drugs but may occur earlier or after many years. The 4 characteristic symptoms usually develop over a few days and often in the following order: Altered mental status: Usually the earliest manifestation is a change in mental status, often an agitated delirium, and may progress to lethargy or unresponsiveness (reflecting encephalopathy). Motor abnormalities: Patients may have generalized, severe muscle rigidity (sometimes with simultaneous tremor, leading to cogwheel rigidity) or, less often, dystonias, chorea, or other abnormalities. Reflex responses tend to be decreased. Hyperthermia: Temperature is usually>38° C and often>40° C. Autonomic hyperactivity: Autonomic activity is increased, tending to cause tachycardia, arrhythmias, tachypnea, and labile hypertension. 