Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome is a potentially lethal condition of unclear cause seen in as many as 1 percent of patients taking neuroleptic medi-cations.I The syndrome was first described in 1959 by Preston2 and is characterized by hyperthermia, muscular rigidity, mental status changes, and autonomic instability. Widespread use of neuroleptic and other psychotropic medi-cations has made the diagnosis and management of neuroleptic malignant syndrome important for all primary care physicians. Case Report A 57-year-old man with an 18-year history of paranoid schizophrenia was successfully managed with trifluoperazine (Stelazine TIl). The patient came to the office with complaints of increasing stiffness, confusion, and anorexia, which were diagnosed as extrapyramidal side effects of his neuroleptic medication. He was treated sequen-tially with oral benztropine (Cogentin TIl), tri-hexyphenidyl (Artane TIl), and diphenhydramine (Benadryl TIl) without success. After 11 days of therapy without improvement, he was admitted to the hospital. The patient was a thin, well-groomed man who walked with a shuffling gait. A mental status ex-amination revealed mild confusion, but no delu-sions or hallucinations. His temperature, blood pressure, and pulse and respiration rates were normal. His facies were masked with marked tongue fasciculations. Extremity examination showed bilateral "lead pipe " rigidity and a coarse hand tremor. On admission a laboratory evaluation of his creatine phosphokinase (CPK) level wa