MRCP revision battle 25.1: Neuroleptic Malignant Syndrome

Having been blessed by a set of on-calls with some nice interesting cases I'm full of enthusiasm for today's battles, so lets get on with it!


MRCP revision battle 25.1: Neuroleptic malignant syndrome
MRCP revision battle 25.2: Behcets disease
MRCP revision battle 25.3: Subarachnoid haemorrhage
MRCP revision battle 25.4: Normal pressure hydrocephalus
MRCP revision battle 25.5: Gas gangrene
MRCP revision battle 25.6: Methaemoglobinaemia
MRCP revision battle 25.7: The weeverfish




MRCP revision battle 25.1: Neuroleptic malignant syndrome


A nice straightfoward battle to begin with...


Neuroleptic malignant syndrome is a life-threatening condition associated with use of antipsychotic drugs.


Symptoms and signs include:

• hyperthermia
• rigidity/muscle cramps
• extrapyramidal signs
• autonomic dysfunction (labile BP, sweating, urinary incontinence
• confusion

Investigations show:

• raised CK
• raised WCC

Treatment is:

• cooling
• dantrolene (a muscle relaxant; note dantrolene is also used in malignant hyperthermia, which will be one of tomorrows battles)

Now on to a slightly less straightforward battle, Behcets disease...

MRCP revision battle 15.8: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome is a condition that can complicate antipsychotic use. 


Its features are:

• pyrexia
• rigidity
• tachycardia

Bloods show:

• raised CK
• leucocytosis
• acidosis

It is commonest in young males, and onset is usually in the first 10 days of taking the drug or after the dose has been increased.


It is important not to miss as it has a 10% mortality.


Treatment is to stop the antipsychotic, give IV fluids, dantrolene and ?bromocriptine.



That's all for today, I'll catch up on the 'wars' tomorrow after I've caught up on sleep!