Neuroleptic malignant syndrome from central nervous system insult: 4 cases and a novel treatment strategy

Abstract

<jats:p>Neuroleptic malignant syndrome (NMS) is a potentially life-threatening entity characterized by hyperthermia, autonomic deregulation, decreased mental status, increased muscle tone, and, frequently, by renal failure due to rhabdomyolysis. Classically, it follows administration of antipsychotic medication.</jats:p> <jats:p>The authors report on 4 patients (2 children and 2 adults) in whom NMS was diagnosed after a CNS insult. No patient was receiving antipsychotic medication. The patients' hospital and clinic charts, radiographic data, and follow-up telephone conversations were reviewed retrospectively.</jats:p> <jats:p>All 4 patients met diagnostic criteria for NMS. Three patients presented with shunt failure, and 1 patient had undergone a functional hemispherectomy 2 days earlier. One patient with shunt failure received the diagnosis retrospectively. An endoscopic third ventriculostomy alleviated his shunt failure and he remains free of NMS. The other 2 patients underwent treatment for shunt failure, but NMS remained. These 2 patients and the one who had undergone hemispherectomy underwent a trial of intrathecal baclofen, and the NMS resolved. Subsequently, an intrathecal baclofen infusion device was placed in all 3 patients, and the NMS resolved. The 2 patients in shunt failure had a lumbar intrathecal baclofen infusion device. The patient who had undergone hemispherectomy had an intracranial baclofen catheter.</jats:p> <jats:p>Neuroleptic malignant syndrome is a rare, life-threatening disorder that can occur without the administration of neuroleptic medications. Alleviation of any CNS insult is the first order of treatment. Some patients with persistent symptoms of NMS may benefit from intrathecal delivery of baclofen.</jats:p>

Status dystonicus: a practice guide

“…In severe status dystonicus the typical patient has an established or evolving dystonia disorder and develops worsening severe generalized dystonia, fever, dehydration, or rhabdomyolysis and respiratory complications. Documentation of the precise evolution of the motor and other features of these disorders is crucial as some children have been diagnosed with neuroleptic malignant syndrome when drugs may not have been involved . ITB withdrawal can produce clinical features resembling status dystonicus …”

“…Documentation of the precise evolution of the motor and other features of these disorders is crucial as some children have been diagnosed with neuroleptic malignant syndrome when drugs may not have been involved. 30,32 ITB withdrawal can produce clinical features resembling status dystonicus. 12,[27][28][29] MANAGEMENT 'Pre-status dystonicus'…”

MR Elastography Can Be Used to Measure Brain Stiffness Changes as a Result of Altered Cranial Venous Drainage During Jugular Compression

“…2 Reduction in venous outflow through the internal jugular veins, through the use of an elastic bandage (neck wrap), has also been used as a treatment for the syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH), 3 also known as negative or low-pressure hydrocephalus, rapidly reversing ventriculomegaly and restoring neurologic function. [4][5][6][7][8] SILPAH is a rare and enigmatic condition in which patients exhibit ventricu-lomegaly and very low intracranial pressure 9 associated with obstruction to the CSF pathways between the ventricles and the subarachnoid space. Despite low intracranial pressure, symptoms mirror those of high intracranial pressure.…”

“…Despite low intracranial pressure, symptoms mirror those of high intracranial pressure. [4][5][6][7][9][10][11][12] The pathophysiology for SILPAH remains unclear. However, changes in brain stiffness as a result of the loss of extracellular fluid 4,8,9,[11][12][13] combined with CSF leaks 6 have been suggested.…”

Stereotactic endoscopic placement of third ventricle catheter for long-term infusion of baclofen in patients with secondary generalized dystonia

“…6 To date, 13 cases treated with intraventricular baclofen infusion have been reported. 1,6,25 We report the use of intraventricular baclofen in 3 additional cases and describe a novel surgical technique. All patients had severe, secondary generalized dystonia as the primary indication for baclofen therapy.…”