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

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening entity characterized by hyperthermia, autonomic deregulation, decreased mental status, increased muscle tone. Find, frequently, by renal failure due to rhabdomyolysis Classically, it follows administration of antipsychotic medication. The authors report on 4 patients (2 children and 2 adults) in whom NMS Was diagnosed after a CNS insult No patient was receiving g antipsychotic medication The patients' hospital and elmic charts. radiographic data. and follow-up telephone conversations were reviewed retrospectively. All 4 patients islet. 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 All endoscopic third ventriculostomy alleviated his shunt failure and tie remain,; free if NMS. The other 2 patients underwent treatment for shunt failure. but NMS remained Those 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 all intracranial baclofen catheter. Neuroleptic malignant syndrome is a rare, life-threatening disorder that cart occur without the administration of neuroleplic medications Alleviation of any CNS instill is the first order of treatment. Some patients with persistent symptoms of NMS may benefit from intrathecal delivery of baclofen. (DOI 10.3171/2009.4.PED.S08444)