atypical neuroleptic malignant syndrome pitfalls and challenges in the delirious substance abuser非典型安定药恶性综合征陷阱和挑战的精神错乱的瘾君子.pdfVIP

Open Journal of Anesthesiology, 2012, 2, 53-57 53 / 10.4236/ojanes.2012.22013 Published Online April 2012 (http://www.SciRP.org/journal/ojanes) Atypical Neuroleptic Malignant Syndrome: Pitfalls and Challenges in the Delirious Substance Abuser 1 1 1 1 1 Nirav N. Shah , Kristin G. Fless , Mikhail Litinski , Fariborz Rezai , Paul C. Yodice , 2 Henry Rosenberg 1Department of Surgery and Critical Care Medicine, St. Barnabas Medical Center, Livingston, USA; 2Department of Medical Educa- tion and Clinical Research, St. Barnabas Medical Center, Livingston, USA. Email: nirav@ Received February 4th, 2012; revised February 26th, 2012; accepted March 4th, 2012 ABSTRACT Introduction: A rare and atypical form of Neuroleptic Malignant Syndrome (NMS) can be a deceptive and life threat- ening condition if not diagnosed properly in acute and critical care settings. Methods: The management of a patient presenting with atypical NMS without prominent rigidity, but with extensive rhabdomyolysis after the administration of haloperidol and ziprasidone is described in this report. Results: Prompt recognition of atypical features of NMS was managed by intensive care unit admission, supportive care and pharmacotherapy, leading to a complete resolution of the syndrome and a favorable outcome verified by laboratory findings. Conclusion: Early stages and atypical features of NMS may be variable in presentation and clinical course. The absence of muscle rigidity may not rule out NMS. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment. Termination of dantrolene therapy may not be necessary during rhabdomyolysis and elevated aminotransferase levels. Keywords: Atypical Neuroleptic Malignant Syndrome; Haloperi