The FEVER Acronym is used to describe the hallmark features of NMS. These are fever, encephalopathy, vitals signs unstable, elevated enzymes (CPK) and rigidity of muscles.
Patients with NMS present often have fever presenting as the initial sign, with temperatures above 38ºC and often above 40ºC. The symptom of fever is due to hypothalamic dopamine receptor blockade.
Neuroleptic malignant syndrome can lead to encephalopathy, which may present in patients as altered mental status, delirium, agitation and even progression to coma.
Those with neuroleptic malignant syndrome have unstable vital signs due to autonomic instability. Typically, tachycardia is seen, along with high blood pressure, tachypnea and diaphoresis.
Patients with this syndrome often have elevated enzymes, with CPK enzyme levels greater than 1000 IU/L. Values this high are more specific for NMS, and there is a direct correlation of CPK elevation with disease severity and prognosis.
Neuroleptic malignant syndrome leads to profound muscle tone, and patients can be described as having a "lead pipe" rigidity.
Because it is theorized that neuroleptic malignant syndrome occurs as a result of dopaminergic receptor blockade, dopaminergic agonists are used to treat this condition.
Bromocriptine is a dopaminergic agonist medication used to restore lost dopaminergic tone in patients with neuroleptic malignant syndrome. This medication should be continued up to 10 days after initial treatment for NMS, and should then be tapered down. Patients can alternatively be given amantadine, which has dopaminergic and cholinergic effects.
Dantrolene is a direct-acting skeletal muscle relaxant and is effective in treating malignant hyperthermia. Another method of medical therapy is with dopaminergic agonists, such as bromocriptine.
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