Neuroleptic Malignant Syndrome in Traumatic Brain Injury Patients Treated With Haloperidol

Bellamy, Cassandra; Kane‐Gill, Sandra L.; Falcione, Bonnie A.; Seybert, Amy L.

doi:10.1097/ta.0b013e31818e90ed

Cited by 28 publications

(24 citation statements)

References 24 publications

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“…[4] The diagnosis in this case was further complicated by the fact that the patient had received a single dose of haloperidol. Previous reports indicate that NMS in traumatic brain injury patients is typically triggered by at least 10 mg of haloperidol, with most patients receiving ≥30 mg.[7] It is important for the intensivist to have NMS on the differential diagnosis for all patients who may be withdrawing from dopaminergic agonists, which must be considered in trauma patients for whom a complete history is not available. [8] Moreover, it must be remembered that neuroleptics have side effects even at home doses, and their use during a period of cocaine withdrawal can lead to an exacerbation of withdrawal symptoms, NMS, or even death.…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome in the trauma intensive care unit: Diagnosis and management of a rare disease in a challenging population

Drews

Christopher

Evans

2017

Int J Crit Illn Inj Sci

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Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder associated with the use of antipsychotic medications. Many of its classic signs, such as fever and altered mental status, are nonspecific in trauma intensive care unit (ICU) patients, and its rarity makes it a difficult diagnosis in this population. However, delays in treatment can be costly both in terms of hospital resources and patient outcomes. We herein report a case of a 54-year-old trauma patient with NMS precipitated by a combination of cocaine withdrawal and neuroleptic medications. Few cases of NMS in the intubated polytrauma patient have been described in the literature previously. Given the poor outcomes associated with this disorder, ICU patients would benefit from risk stratification and avoidance of neuroleptic medications in those at highest risk for NMS, particularly patients who are withdrawing from dopaminergic agents.

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Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome in the trauma intensive care unit: Diagnosis and management of a rare disease in a challenging population

Drews

Christopher

Evans

2017

Int J Crit Illn Inj Sci

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“…[25–11] Younger patients are at higher risk for the development of NMS, it is twice more common in male, the reported incidence of NMS with use of haloperidol is ranging from 0.02 to 12.2%. [4]…”

Section: Discussionmentioning

confidence: 99%

“…None of the cases reported NMS in head injury patients had mortality. [4] Higher levels of CPK in these patients indicate the severity of the disease and correlate with the higher mortality. Dentrolene and bromocriptin therapy will reduce the morbidity and mortality in NMS patients.…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome and closed head injury: A case report and review

et al. 2011

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Neuroleptic malignant syndrome (NMS) is a rare, but potentially lethal neurological emergency. Fifty percent of traumatic brain injury (TBI) patients will have emotional disorders and post-traumatic agitations. Haloperidol is a neuroleptic antipsychotic medication commonly used in the traumatic brain injury patients due to its advantage of no effect on respiration and conscious level. But it is one of the common medications causing NMS. A 19-year-old male driver involved in the road traffic accident had an acute subdural hematoma, which was immediately evacuated. Postoperatively, he was awake. He was weaned from ventilator and extubated. He received 20 mg of intravenous haloperidol in divided doses with in 24 hours to control his agitation. Next day, he became drowsy, spastic, febrile, and tachycardic with labile blood pressure. He was diagnosed to have NMS, needed intubation, aggressive hydration and pharmacological treatment with dentrolene sodium and bromocriptin. He was weaned from ventilator and extubated on day 17. He was transferred to the ward and then discharged to be followed in out-patient clinic. NMS in head injury patient is rare and difficult to diagnose. Diagnosis of NMS should be suspected if two of the four cardinal signs and symptoms are developed following the use of neuroleptic or dopamine agonist medication withdrawal.

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“…It was concluded that patients with traumatic brain injury should be monitored closely, especially if they are receiving haloperidol parenterally at high doses. It is important to note that haloperidol may have negative effects on cognition and function, making it an unattractive medication in this patient population (46). The development of heme pigment-associated renal failure from rhabdomyolysis is an important risk factor for mortality (30).…”

Section: Nmsmentioning

confidence: 99%

Adverse drug reactions resulting in hyperthermia in the intensive care unit

McAllen

Schwartz

2010

Critical Care Medicine

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Hyperthermia is frequently seen in the intensive care setting and is associated with significant morbidity and mortality. It is often initially misdiagnosed as fever associated with infection. Atypical presentations of classic syndromes are common. Clinical suspicion is the key to diagnosis. Adverse drug reactions are a frequent culprit. Syndromes include adrenergic "fever," anticholinergic "fever," antidopaminergic "fever," serotonin syndrome, malignant hyperthermia, uncoupling of oxidative phosphorylation, and withdrawal from baclofen. This review describes the pathophysiology of hyperthermia, as distinct from fever, and the physiology, diagnosis, and treatment of serotonin syndrome, neuroleptic malignant syndrome, malignant hyperthermia, and baclofen withdrawal. Much of the available evidence regarding the treatment of these disorders is based on single case reports, case series, or animal models. Therapeutic modalities consist of identification/withdrawal of possible offending agent(s), support directed at lowering temperature and preventing/treating complications, as well as targeted pharmacologic therapy directed at the specific cause. Early recognition and treatment using a multidisciplinary approach are essential to achieve the best possible outcome.

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Neuroleptic Malignant Syndrome in Traumatic Brain Injury Patients Treated With Haloperidol

Cited by 28 publications

References 24 publications

Neuroleptic malignant syndrome in the trauma intensive care unit: Diagnosis and management of a rare disease in a challenging population

Neuroleptic malignant syndrome in the trauma intensive care unit: Diagnosis and management of a rare disease in a challenging population

Neuroleptic malignant syndrome and closed head injury: A case report and review

Adverse drug reactions resulting in hyperthermia in the intensive care unit

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