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Neuroleptic Malignant Syndrome
Diagnosis of Neuroleptic Malignant Syndrome
Clinical evaluation Exclusion of other disorders and complications Neuroleptic malignant syndrome should be suspected based on clinical findings. Early manifestations can be missed because mental status changes may be overlooked or dismissed in patients with psychosis. Other disorders can cause similar findings. For example: Serotonin Syndrome tends to cause rigidity, hyperthermia, and autonomic hyperactivity, but it is usually caused by selective serotonin reuptake inhibitors (SSRIs) or other serotonergic drugs, and patients typically have hyperreflexia and sometimes myoclonus. Also, temperature elevations and muscle rigidity are usually less severe than in neuroleptic malignant syndrome, onset may be rapid (eg, Malignant Hyperthermia and withdrawal of intrathecal Nonconvulsive status epilepticus can cause altered mental status, rigidity, and hyperthermia. Electroencephalography should be obtained to exclude status epilepticus. Systemic infections, including Sepsis and Septic Shock , pneumonia, and central nervous system infection, can cause altered mental status, hyperthermia, and tachypnea and tachycardia, but generalized motor abnormalities are not expected. Also, in neuroleptic malignant syndrome, unlike most infections, altered mental status and motor abnormalities tend to precede hyperthermia. There are no confirmatory tests, but patients should have testing for complications, including serum electrolytes, bloodureanitrogen, creatinine, glucose, calcium, magnesium, and creatine kinase, urine myoglobin, and usually neuroimaging and cerebrospinal fluid analysis. 