Neuroleptic malignant syndrome: case report

Neuroleptic malignant syndrome (NMS) is an infrequent, but potentially life-threatening neurologic emergency associated with the use of neuroleptic or antipsychotic drugs. A 43 years old male with a history of trigeminal neuralgia developed Neuroleptic malignant syndrome while receiving Carbamazepine and Amitryptylline. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. Complications of NMS include acute renal failure and acute respiratory failure. The possible etiologies, triggering factors and treatment are discussed with reference to existing literature.

Intraparenchymal Cerebral Hemorrhage

Intraparenchymal cerebral hemorrhage (ICH) is the presence of blood in the brain parenchyma. It is a neurologic emergency and may carry severe morbidity and death. This chapter focuses mainly on spontaneous, nontraumatic ICH (ie, hemorrhage not related to trauma, arteriovenous malformation, cerebral aneurysm, or tumor). ICH accounts for 15% to 20% of all new strokes annually. Among the US general population, the incidence is 15 cases per 100,000 person-years.

Acute Spinal Cord Compression, Spinal Cord Trauma, and Peripheral Neural Injury

Acute spinal cord compression with myelopathy is a neurologic emergency. Recognition of spinal cord compression, timely imaging, and treatment are important to restore and preserve neurologic function. This chapter reviews the causes and clinical approach to spinal cord compression. Traumatic and nontraumatic causes of spinal cord compression are addressed together because of their overlapping symptoms and management. The chapter concludes with a brief discussion of peripheral nerve injury.

Status Epilepticus

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting more than 5 minutes or recurrent seizures without recovery of consciousness in between. When seizures persist despite adequate doses of first- and second-line antiepileptic agents, the condition is called refractory SE. Super-refractory SE occurs when seizure activity continues or recurs 24 hours after the initiation of therapy with anesthetic agents.

Secondary Headache Disorders

In the evaluation of a patient with headache, the first task is to differentiate between a secondary headache and a primary headache. This step is essential because secondary causes of headache may require vastly different evaluation and treatment than primary headache disorders. Thunderclap headache (TCH) is an acute, severe headache with an abrupt onset, reaching maximum intensity in less than 1 minute. TCH is a neurologic emergency and should immediately prompt an urgent evaluation for a secondary headache.

Acute Ischemic Stroke Evaluation and Treatment

Acute ischemic stroke is a neurologic emergency where an estimated 2 million neurons a minute are lost secondary to ischemia. Treatments of acute stroke are directed at early revascularization of the occluded vessel and to preserve neuronal death and improve collateral flow. Treatments are time sensitive, an aspect that places great importance on early symptom recognition, correct diagnosis, and clinical management. In acute ischemic stroke, in short, “time is brain.”

Neuroleptic Malignant Syndrome Applied with Targeted Temperature Management

Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications. NMS is characterized by refractory hyperpyrexia, altered mental state, dysautonomia, and rigor. If hyperpyrexia persists, it can result in multiorgan failure. Herein, we report a case of NMS occurring after metoclopramide administration in a patient with pontine hemorrhage, which was successfully treated with targeted temperature management using a surface cooling device.

Pediatric Patient with Ischemic Stroke: Initial Approach and Early Management

Acute Ischemic Stroke (AIS) in children is an acute neurologic emergency associated with significant morbidity and mortality. Although the incidence of AIS in pediatric patients is considerably lower than in adults, the overall cumulative negative impact of the quality of life could be even higher in children. The age-related variable clinical presentation could result in a delay in diagnosis and could negatively influence the overall outcome. The early management should be based on early recognition, acute transfer to pediatric AIS centre, standardised approach (ABCDE), early neurologic examination together with neuroimaging (preferable Magnetic Resonance Imaging—MRI). The treatment is based on supportive therapy (normoxemia, normocapnia, normotension and normoglycemia) in combination with intravenous/intraarterial thrombolytic therapy and/or mechanical thrombectomy in selected cases. Pediatric stroke centres, together with the implementation of local stroke management protocols, could further improve the outcome of pediatric patients with AIS.

Convulsive Status Epilepticus in a Cohort of Patients from a Peruvian Academic Hospital

Background and Purpose: Status epilepticus is a neurologic emergency whose epidemiology, etiology and management are scarcely known in developing countries. Our objective was to describe the demographic and clinical features as well as the management of generalized convulsive status epilepticus (GCSE) in adult patients admitted to the emergency department of an academic hospital in Peru, between March 2019 and March 2020.Methods: Observational study of a prospective cohort in which patients were assessed by the emergency and neurology department on the first day of hospitalization, at discharge and at 30 days post-discharge in a follow-up visit. Relevant demographics and clinical data were collected. After being encoded and sorted, univariate statistical analysis was carried out.Results: Of the sample of 59 patients, 62.7% were males, 57.6% were unemployed, 89.8% did not finish high school, and 55.9% had intermittent GCSE with no seizure at arrival. The total calculated median times were: 60 minutes from GCSE onset to hospital arrival, 110 minutes from GCSE onset to 1st line therapy, and 7 minutes from hospital arrival to 1st line therapy. The most frequently used antiepileptic drugs were one dose of benzodiazepine (41.7%), phenytoin (76.9%), and additional doses of benzodiazepines (60%) for 1st, 2nd, and 3rd line therapies, respectively. The most frequent etiologies were antiepileptic drug suspension (27.1%), undetermined (25.4%) and acute stroke (11.8%). 62.71% had 0-2 modified Rankin score at discharge.Conclusions: In this cohort of patients, GCSE was mainly intermittent. Management times differed from the guidelines’ recommendations.