Coexistence of guanidinoacetate methyltransferase (GAMT) deficiency and neuroleptic malignant syndrome without creatine kinase elevation

2020 ◽  
Vol 42 (5) ◽  
pp. 418-420 ◽  
Author(s):  
Müge Ayanoğlu ◽  
Elif Korgali ◽  
Taner Sezer ◽  
Halil Ibrahim Aydin ◽  
Fatma Müjgan Sönmez
Keyword(s):  
Creatine Kinase ◽  
Neuroleptic Malignant Syndrome ◽  
Gamt Deficiency

Neuroleptic Malignant Syndrome Associated with the Use of Prochlorperazine in a Patient with a Recent History of Antipsychotic-Induced Neuroleptic Malignant Syndrome

2011 ◽  
Vol 45 (11) ◽  
pp. 1453-1453 ◽  
Author(s):  
Megan E Musselman ◽  
Linda A Browning ◽  
Dennis Parker ◽  
Suprat Saely
Keyword(s):  
Creatine Kinase ◽  
Blood Cell ◽  
Cell Count ◽  
Neuroleptic Malignant Syndrome ◽  
Blood Urea Nitrogen ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cell Count ◽  
Urea Nitrogen ◽  
History Of

Objective: To describe a case of neuroleptic malignant syndrome (NMS) associated with the use of prochlorperazine in a patient recently hospitalized for NMS secondary to olanzapine. Case Summary: A 28-year-old African American male with a history of schizophrenia was hospitalized 22 days prior to the current admission for an episode of olanzapine-induced NMS. The patient was discharged from our hospital to an outside psychiatric facility. At this facility, the patient developed nausea and was given 2 doses (unknown amount and route) of prochlorperazine. Over the next 24 hours, the patient exhibited signs and symptoms of NMS including fever, agitation, and muscle rigidity. He was transported to the emergency department and became increasingly agitated. Upon admission, the patient was hyperthermic (rectal temperature 39 °C) and tachycardic (heart rate 138 beats/min), with an elevated white blood cell count of 13.5 × 103/μL, creatine kinase 431 units/L, serum sodium 150 mEq/L, blood urea nitrogen 25 mg/dL, and creatinine 1.1 mg/dL A diagnosis of NMS was speculated and infectious causes were excluded. The patient was treated with aggressive fluid resuscitation and rapid cooling measures, as well as bromocriptine and lorazepam. Cooling measures were used for 48 hours, during which time the creatine kinase, white blood cell count, sodium, blood urea nitrogen, and creatinine gradually normalized. The patient was discharged to a psychiatry facility with a treatment regimen of oxcarbazepine 600 mg twice daily, lorazepam 2 mg 3 times daily, and clozapine 25 mg at bedtime, which was titrated over 2 months to 200 mg twice daity. There have been no further occurrences of NMS. Discussion: The patient had all of the major characteristics of NMS with no other likely causative factors that may have contributed to his illness. Use of the Naranjo probability scale suggested that NMS was probably related to prochlorperazine. This case highlights the potential increased risk with the use of prochlorperazine in a patient with a history of olanzapine-induced NMS. Conclusions: NMS should be considered as a rare complication of therapy with antipsychotics and agents that alter dopamine activity, especially in patients with a history of the syndrome. Careful consideration should be given regarding the risks and benefits of using non-antipsychotic dopamine antagonists in patients with a history of antipsychotic-induced NMS.

Neuroleptic Malignant Syndrome Complicating Closed Head Injury

Neurosurgery ◽  
1986 ◽  
Vol 18 (2) ◽  
pp. 190-193 ◽  
Author(s):  
Frederick M. Vincent ◽  
J. Eric Zimmerman ◽  
James Van Haren
Keyword(s):  
Creatine Kinase ◽  
Head Injury ◽  
Neuroleptic Malignant Syndrome ◽  
Complete Resolution ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Treatment Modalities ◽  
Dantrolene Sodium ◽  
Closed Head Injuries ◽  
Closed Head

Abstract Lethargy, hyperpyrexia, tremor, and rigidity associated with leukocytosis and elevation of the creatine kinase level occurred in a patient with a closed head injury who was being treated with haloperidol for control of agitation. This constellation of symptoms, known as the neuroleptic malignant syndrome (NMS), partially improved when the neuroleptic medication was stopped, but complete resolution of the syndrome did not occur until the patient was treated with bromocriptine. Because haloperidol is the most widely used medication for the agitation that develops in patients with significant closed head injuries, neurosurgeons should be aware of the NMS. The NMS is caused by neuroleptic medications and may initially present with unexplained hyperpyrexia, leukocytosis, and elevated creatine kinase levels. Halting the neuroleptic, supportive care, and the use of dantrolene sodium and bromocriptine are the treatment modalities of choice for this syndrome, which has a mortality rate of 20 to 30% and may be linked to malignant hyperthermia.

Suspected Neuroleptic Malignant Syndrome in a Patient Receiving Clozapine

1996 ◽  
Vol 30 (3) ◽  
pp. 248-250 ◽  
Author(s):  
Luba Ganelin ◽  
Pesach S Lichtenberg ◽  
Esther-Lee Marcus ◽  
R Gabriel Munter
Keyword(s):  
Creatine Kinase ◽  
Neuroleptic Malignant Syndrome ◽  
Supportive Therapy ◽  
Serum Creatine Kinase ◽  
Clozapine Therapy ◽  
Antipsychotic Medications ◽  
Case Summary ◽  
Pharmacologic Profile

OBJECTIVE: To report a case of suspected neuroleptic malignant syndrome (NMS) associated with clozapine therapy. CASE SUMMARY: A 42-year-old schizophrenic man treated with clozapine developed a temperature of 39.5 °C, diaphoresis, tachycardia, rigidity, and leukocytosis. His serum creatine kinase concentration was 25 000 U/L. A diagnosis of NMS was made. He was treated with bromocriptine and supportive therapy, and recovered within a week. DISCUSSION: Despite earlier expectations that clozapine, with a pharmacologic profile differing from that of other antipsychotic medications, might not cause NMS, NMS remains the most likely diagnosis in this case. CONCLUSIONS: NMS may be a possible complication of clozapine therapy.

The role of creatine kinase in the diagnosis of Neuroleptic Malignant Syndrome

1993 ◽  
Vol 23 (2) ◽  
pp. 323-326 ◽  
Author(s):  
Anne-Marie O'Dwyer ◽  
Noel P. Sheppard
Keyword(s):  
Creatine Kinase ◽  
Antibiotic Therapy ◽  
Neuroleptic Malignant Syndrome ◽  
Psychotropic Medication ◽  
Reference Value ◽  
Serum Creatine Kinase ◽  
Specific Finding ◽  
Infectious Illness ◽  
Diagnostic Criterion

SynopsisElevation of serum creatine kinase (CK) concentrations occurs almost invariably in neuroleptic malignant syndrome (NMS). However, the role of CK levels in the diagnosis of the syndrome remains controversial. This study measured CK levels in patients who became pyrexial while on psychotropic medication and thereby mimicked some of the features of NMS. In all of these cases a diagnosis of infectious illness was made and patients responded to appropriate antibiotic therapy without alteration in psychotropic medication. Two other groups were studied for comparison – patients on psychotropics who were apyrexial and patients who became pyrexial but were not on psychotropics. Significant, unexpected elevations of CK were documented in 70% of those patients who became pyrexial while on psychotropics – in three cases elevation of concentrations to more than 1000 IU/1 (ten times reference value) were found. Thirty per cent of patients who became pyrexial but were not on psychotropics also developed elevation of CK but this was of a much smaller magnitude (lt; 200 IU/1 in five out of six cases). The results of the study suggest that elevation of CK is a non-specific finding, particularly in patients who become pyrexial on psychotropics. Use of CK as a diagnostic criterion may lead to overdiagnosis of NMS.

Neuroleptic Malignant Syndrome: Uncommon Postoperative Diagnostic Dilemma

2002 ◽  
Vol 10 (4) ◽  
pp. 365-366
Author(s):  
Suraj Bhan ◽  
Vinay Kulkarni ◽  
Yatin Mehta ◽  
Krishan Kant Sharma ◽  
Naresh Trehan ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Neuroleptic Malignant Syndrome ◽  
Coronary Artery Bypass ◽  
Liver Enzymes ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Diagnostic Dilemma ◽  
Artery Bypass Grafting

Neuroleptic malignant syndrome occurred in a 71-year-old man on haloperidol therapy for mild depressive dementia. After coronary artery bypass grafting, he developed hyperthermia, elevated creatine kinase without a corresponding rise in the MB-isoenzyme, leukocytosis, raised liver enzymes, urea, and creatinine. His condition responded to bromocriptine therapy.

Neuroleptic Malignant Syndrome: A Potential Etiology of Multisystem Organ Failure in a Burn Patient

2020 ◽  
pp. 000313482094524 ◽  
Author(s):  
Hannah M. Ficarino ◽  
Michael Z. Caposole ◽  
S. Noelle Davis ◽  
Mackenzie N. Krebsbach ◽  
Emily F. McGowin ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Organ Failure ◽  
Neuroleptic Malignant Syndrome ◽  
Total Body Surface Area ◽  
Elevated Serum ◽  
Trauma Patients ◽  
Antipsychotic Therapy ◽  
Coronary Syndrome ◽  
Multisystem Organ Failure ◽  
Patient Reported

Neuroleptic malignant syndrome (NMS) is described in the medical literature but rarely seen among acutely ill trauma patients. A 44-year-old man with burns to the hands and back after a chemical explosion was transported to an outside facility where he received treatment for presumed acute coronary syndrome after developing ventricular tachycardia and elevated serum troponins after the exposure. His cardiac catheterization was unremarkable, but an echocardiogram revealed severe cardiomyopathy, and he was also in multisystem organ failure. He was transferred to our facility after hospital day 2 for treatment of his multisystem organ failure and 2% total body surface area burns. His laboratory results were remarkable for a creatine kinase of >100 000 units/L, and he required 14 g of intravenous calcium. Upon further investigation, the patient reported taking ziprasidone for his bipolar disorder, and he had a core temperature of 103.5 °F on his initial presentation to the outside facility. As he convalesced, the unifying diagnosis was NMS. NMS is a side effect of antipsychotic therapy and is manifested by hyperpyrexia, rigidity, autonomic instability, and altered consciousness. An elevated creatine kinase >100 000 units/L is almost pathognomonic for NMS. Patients can also present with leukocytosis, organ failure, and electrolyte disturbances including hypocalcemia. We hypothesized that dehydration, the warm environmental conditions at our patient’s job, and immense stress resulting in a catecholamine surge following his trauma were inciting triggers to this event. This case highlights the importance of considering alternate diagnoses in patients whose clinical presentation does not fit the most “obvious cause.”

Rhabdomyolysis secondary to severe tic fits

2021 ◽  
Vol 14 (3) ◽  
pp. e239874
Author(s):  
Ka Loong Kelvin Au ◽  
Shannon Chiu ◽  
Irene A Malaty
Keyword(s):  
Quality Of Life ◽  
Creatine Kinase ◽  
Neuroleptic Malignant Syndrome ◽  
Tourette Syndrome ◽  
Intravenous Fluids ◽  
Potential Complication ◽  
Laboratory Parameters ◽  
Elevated Creatine Kinase ◽  
Neuroleptic Therapy

Tourette syndrome (TS) is a condition wherein motor and vocal tics occur, provoked by an urge, but often not able to be completely voluntarily controlled. Tics are known to cause physical and emotional risks to quality of life, and in rare extreme cases, may have permanent consequences. We report the first cases, to our knowledge, of rhabdomyolysis due to extreme tic fits in two distinct patients with TS. Both patients presented with severe tics, leading to elevated creatine kinase and a diagnosis of rhabdomyolysis requiring hospitalisation and intravenous fluids. Neither had neuroleptic malignant syndrome. One patient was on concurrent neuroleptic therapy, but his laboratory parameters improved when tics subsided despite continued neuroleptic use. Our cases highlight the potential complication of rhabdomyolysis secondary to severe tic fits independent of neuroleptic use.

Successful management of a patient with neuroleptic malignant syndrome associated with marked elevation of serum creatine kinase

2004 ◽  
Vol 18 (2) ◽  
pp. 135-137
Author(s):  
Daisuke Takizawa ◽  
Koichi Nishikawa ◽  
Haruhiko Hiraoka ◽  
Hiroshi Hinohara ◽  
Shigeru Saito ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Neuroleptic Malignant Syndrome ◽  
Serum Creatine Kinase ◽  
Successful Management ◽  
Marked Elevation
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