The great masquerader: Atypical neuroleptic malignant syndrome after cardiac surgery

摘要

NEUROLEPTIC MALIGNANT SYNDROME (NMS) is a rare and sometimes fatal adverse condition attributed to the administration of antipsychotic medications and dopamine antagonists or the rapid withdrawal of antiparkinsonian medications. Several approaches to diagnostic criteria have been suggested focusing on the hallmark symptoms of NMS, most notably hyperthermia and muscular rigidity presenting with a variable combination of other minor symptoms and abnormal laboratory values (including autonomic instability, diaphoresis, altered consciousness, elevated creatine kinase [CK], and leu-kocytosis). Although the diagnosis of NMS remains one of exclusion, an increasing body of literature has described atypical variations of NMS, often lacking hyperthermia or muscular rigidity and, thus, not conforming to the accepted diagnostic criteria. The authors present a case and discussion in which the diagnosis and treatment of a postoperative cardiothoracic surgical patient were based on that of an atypical form of NMS occurring after the administration of parenteral metoclopramide (Baxter Healthcare Corporation, Deerfield, IL) and haloperidol (Teva Pharmaceuticals, North Wales, PA).